1
|
Cabey W, Duffield O, Hart B, Stern S, Tuohy B. Revive and Respect: Using Structural Competency and Humility to Reframe Discussions of Decision-Making Capacity. Am J Bioeth 2024; 24:27-30. [PMID: 38635436 DOI: 10.1080/15265161.2024.2327306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/20/2024]
Affiliation(s)
- Whitney Cabey
- Center for Urban Bioethics, Lewis Katz School of Medicine at Temple University
| | - Olivia Duffield
- Center for Urban Bioethics, Lewis Katz School of Medicine at Temple University
| | - Brendan Hart
- Center for Urban Bioethics, Lewis Katz School of Medicine at Temple University
| | - Sam Stern
- Center for Urban Bioethics, Lewis Katz School of Medicine at Temple University
| | - Brian Tuohy
- Center for Urban Bioethics, Lewis Katz School of Medicine at Temple University
| |
Collapse
|
2
|
Barsky BA. Law Enforcement Interventionism as Determinant of Decision-Making Among Resuscitated Opioid Users. Am J Bioeth 2024; 24:40-42. [PMID: 38635424 DOI: 10.1080/15265161.2024.2327282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/20/2024]
|
3
|
Cattell C, Hyshka E, Leier B, Mack C. Capacity, Rationality, and the Promotion of Autonomy: A Trauma-Informed Approach to Refusals of Care After Opioid Poisoning. Am J Bioeth 2024; 24:48-51. [PMID: 38635442 DOI: 10.1080/15265161.2024.2327285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/20/2024]
|
4
|
Burdman F. Autonomy, Thin and Thick. Am J Bioeth 2024; 24:53-55. [PMID: 38635441 DOI: 10.1080/15265161.2024.2327284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/20/2024]
|
5
|
Holt G, Schwan B. Autonomy-Based Obligations to Patients in the Emergency Department Following Opioid Overdose. Am J Bioeth 2024; 24:56-58. [PMID: 38635432 DOI: 10.1080/15265161.2024.2329252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/20/2024]
|
6
|
Marshall KD, Derse AR, Weiner SG, Joseph JW. Revive and Refuse: Capacity, Autonomy, and Refusal of Care After Opioid Overdose. Am J Bioeth 2024; 24:11-24. [PMID: 37220012 DOI: 10.1080/15265161.2023.2209534] [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] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Physicians generally recommend that patients resuscitated with naloxone after opioid overdose stay in the emergency department for a period of observation in order to prevent harm from delayed sequelae of opioid toxicity. Patients frequently refuse this period of observation despiteenefit to risk. Healthcare providers are thus confronted with the challenge of how best to protect the patient's interests while also respecting autonomy, including assessing whether the patient is making an autonomous choice to refuse care. Previous studies have shown that physicians have widely divergent approaches to navigating these conflicts. This paper reviews what is known about the effects of opioid use disorder on decision-making, and argues that some subset of these refusals are non-autonomous choices, even when patients appear to have decision making capacity. This conclusion has several implications for how physicians assess and respond to patients refusing medical recommendations after naloxone resuscitation.
Collapse
|
7
|
S Wright M. Hospitals Are Not Prisons: Decision-Making Capacity, Autonomy, and the Legal Right to Refuse Medical Care, Including Observation. Am J Bioeth 2024; 24:37-39. [PMID: 38635433 DOI: 10.1080/15265161.2024.2327293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/20/2024]
|
8
|
A Marco C. Opioid Overdose and Capacity. Am J Bioeth 2024; 24:33-34. [PMID: 38635426 DOI: 10.1080/15265161.2024.2327298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/20/2024]
|
9
|
Smith JN, Smolenski J, Lang BH, Blumenthal-Barby J. From Opioid Overdose to LVAD Refusals: Navigating the Spectrum of Decisional Autonomy. Am J Bioeth 2024; 24:8-10. [PMID: 38635427 DOI: 10.1080/15265161.2024.2329496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/20/2024]
Affiliation(s)
| | | | - Ben H Lang
- Baylor College of Medicine
- Oxford University
| | | |
Collapse
|
10
|
Engel GR, Boyd JW. Everyone With an Addiction Has Diminished Decision-Making Capacity. Am J Bioeth 2024; 24:34-37. [PMID: 38635447 DOI: 10.1080/15265161.2024.2327289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/20/2024]
|
11
|
Guta A, Gagnon M, German D, Buchman DZ, Strike CJ. Resisting Inadequate Care is Not Irrational, and Coercive Treatment is Not an Appropriate Response to the Drug Toxicity Crises. Am J Bioeth 2024; 24:42-45. [PMID: 38635440 DOI: 10.1080/15265161.2024.2327287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/20/2024]
Affiliation(s)
- Adrian Guta
- School of Social Work, University of Windsor
| | | | | | | | - Carol J Strike
- Dalla Lana School of Public Health, University of Toronto
| |
Collapse
|
12
|
Riggs KR, Kertesz SG. Illuminating the Consequentialist Logic of Harm Reduction After Overdose Through a Hypothetical Randomized Trial. Am J Bioeth 2024; 24:45-48. [PMID: 38635430 PMCID: PMC11034905 DOI: 10.1080/15265161.2024.2327277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/20/2024]
Affiliation(s)
- Kevin R. Riggs
- Division of Preventive Medicine, UAB Heersink School of Medicine, Birmingham, Alabama, United States
- Birmingham VA Medical Center, Birmingham, Alabama, United States
| | - Stefan G. Kertesz
- Division of Preventive Medicine, UAB Heersink School of Medicine, Birmingham, Alabama, United States
- Birmingham VA Medical Center, Birmingham, Alabama, United States
| |
Collapse
|
13
|
Racine E. Autonomy and Its Constrictive Effects on Our Ethical Lenses and Imaginations. Am J Bioeth 2024; 24:25-27. [PMID: 38635444 DOI: 10.1080/15265161.2024.2327302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/20/2024]
Affiliation(s)
- Eric Racine
- Institut de recherches cliniques de Montréal
- Université de Montréal
- McGill University
| |
Collapse
|
14
|
Montoya ID, Watson C, Aldridge A, Ryan D, Murphy SM, Amuchi B, McCollister KE, Schackman BR, Bush JL, Speer D, Harlow K, Orme S, Zarkin GA, Castry M, Seiber EE, Barocas JA, Linas BP, Starbird LE. Cost of start-up activities to implement a community-level opioid overdose reduction intervention in the HEALing Communities Study. Addict Sci Clin Pract 2024; 19:23. [PMID: 38566249 PMCID: PMC10988809 DOI: 10.1186/s13722-024-00454-w] [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: 04/02/2023] [Accepted: 03/18/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Communities That HEAL (CTH) is a novel, data-driven community-engaged intervention designed to reduce opioid overdose deaths by increasing community engagement, adoption of an integrated set of evidence-based practices, and delivering a communications campaign across healthcare, behavioral-health, criminal-legal, and other community-based settings. The implementation of such a complex initiative requires up-front investments of time and other expenditures (i.e., start-up costs). Despite the importance of these start-up costs in investment decisions to stakeholders, they are typically excluded from cost-effectiveness analyses. The objective of this study is to report a detailed analysis of CTH start-up costs pre-intervention implementation and to describe the relevance of these data for stakeholders to determine implementation feasibility. METHODS This study is guided by the community perspective, reflecting the investments that a real-world community would need to incur to implement the CTH intervention. We adopted an activity-based costing approach, in which resources related to hiring, training, purchasing, and community dashboard creation were identified through macro- and micro-costing techniques from 34 communities with high rates of fatal opioid overdoses, across four states-Kentucky, Massachusetts, New York, and Ohio. Resources were identified and assigned a unit cost using administrative and semi-structured-interview data. All cost estimates were reported in 2019 dollars. RESULTS State-level average and median start-up cost (representing 8-10 communities per state) were $268,657 and $175,683, respectively. Hiring and training represented 40%, equipment and infrastructure costs represented 24%, and dashboard creation represented 36% of the total average start-up cost. Comparatively, hiring and training represented 49%, purchasing costs represented 18%, and dashboard creation represented 34% of the total median start-up cost. CONCLUSION We identified three distinct CTH hiring models that affected start-up costs: hospital-academic (Massachusetts), university-academic (Kentucky and Ohio), and community-leveraged (New York). Hiring, training, and purchasing start-up costs were lowest in New York due to existing local infrastructure. Community-based implementation similar to the New York model may have lower start-up costs due to leveraging of existing infrastructure, relationships, and support from local health departments.
Collapse
Affiliation(s)
- Iván D Montoya
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | | | | | - Danielle Ryan
- Department of Population Health Sciences, Weill Cornell Medical College, New York, NY, USA
| | - Sean M Murphy
- Department of Population Health Sciences, Weill Cornell Medical College, New York, NY, USA
| | - Brenda Amuchi
- Section of General Internal Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Kathryn E McCollister
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Bruce R Schackman
- Department of Population Health Sciences, Weill Cornell Medical College, New York, NY, USA
| | - Joshua L Bush
- College of Public Health, University of Kentucky, Lexington, KY, USA
| | - Drew Speer
- College of Public Health, University of Kentucky, Lexington, KY, USA
| | - Kristin Harlow
- College of Public Health, The Ohio State University, Columbus, OH, USA
| | - Stephen Orme
- RTI International, Research Triangle Park, NC, USA
| | | | - Mathieu Castry
- Section of General Internal Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Eric E Seiber
- College of Public Health, The Ohio State University, Columbus, OH, USA
| | - Joshua A Barocas
- Sections of General Internal Medicine and Infectious Diseases, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Benjamin P Linas
- Section of General Internal Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Laura E Starbird
- Department of Family and Community Health, University of Pennsylvania School of Nursing, Philadelphia, PA, USA.
| |
Collapse
|
15
|
Chakravartula S, Thrasher B, Mann J, Chaturbedi A, Han X, Dahan A, Florian J, Strauss D, Li Z. Physiologically based modeling reveals different risk of respiratory depression after fentanyl overdose between adults and children. Clin Transl Sci 2024; 17:e13780. [PMID: 38618722 PMCID: PMC11017203 DOI: 10.1111/cts.13780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 03/01/2024] [Accepted: 03/14/2024] [Indexed: 04/16/2024] Open
Abstract
Despite a rapid increase in pediatric mortality rate from prescription and illicit opioids, there is limited research on the dose-dependent impact of opioids on respiratory depression in children, the leading cause of opioid-associated death. In this article, we extend a previously developed translational model to cover pediatric populations by incorporating age-dependent pharmacokinetic, pharmacodynamic, and physiological changes compared to adults. Our model reproduced previous perioperative clinical findings that adults and children have similar risk of respiratory depression at the same plasma fentanyl concentration when specific endpoints (minute ventilation, CO2 tension in the blood) were used. However, our model points to a potential caveat that, in a perioperative setting, routine use of mechanical ventilation and supplemental oxygen maintained the blood and tissue oxygen partial pressures in patients and prevented the use of oxygen-related endpoints to evaluate the consequences of respiratory depression. In a community setting when such oxygenation procedures are not immediately available, our model suggests that the higher oxygen demand and reduced cerebrovascular reactivity could make children more susceptible to severe hypoxemia and brain hypoxia, even with the same plasma fentanyl concentration as adults. Our work indicates that when developing intervention strategies to protect children from opioid overdose in a community setting, these pediatric-specific factors may need to be considered.
Collapse
Affiliation(s)
- Shilpa Chakravartula
- Division of Applied Regulatory Science, Office of Clinical Pharmacology, Office of Translational SciencesCenter for Drug Evaluation and Research, Food and Drug AdministrationSilver SpringMarylandUSA
| | - Bradlee Thrasher
- Division of Applied Regulatory Science, Office of Clinical Pharmacology, Office of Translational SciencesCenter for Drug Evaluation and Research, Food and Drug AdministrationSilver SpringMarylandUSA
| | - John Mann
- Division of Applied Regulatory Science, Office of Clinical Pharmacology, Office of Translational SciencesCenter for Drug Evaluation and Research, Food and Drug AdministrationSilver SpringMarylandUSA
| | - Anik Chaturbedi
- Division of Applied Regulatory Science, Office of Clinical Pharmacology, Office of Translational SciencesCenter for Drug Evaluation and Research, Food and Drug AdministrationSilver SpringMarylandUSA
| | - Xiaomei Han
- Division of Applied Regulatory Science, Office of Clinical Pharmacology, Office of Translational SciencesCenter for Drug Evaluation and Research, Food and Drug AdministrationSilver SpringMarylandUSA
| | - Albert Dahan
- Leiden University Medical CenterLeidenThe Netherlands
| | - Jeffry Florian
- Division of Applied Regulatory Science, Office of Clinical Pharmacology, Office of Translational SciencesCenter for Drug Evaluation and Research, Food and Drug AdministrationSilver SpringMarylandUSA
| | - David Strauss
- Division of Applied Regulatory Science, Office of Clinical Pharmacology, Office of Translational SciencesCenter for Drug Evaluation and Research, Food and Drug AdministrationSilver SpringMarylandUSA
| | - Zhihua Li
- Division of Applied Regulatory Science, Office of Clinical Pharmacology, Office of Translational SciencesCenter for Drug Evaluation and Research, Food and Drug AdministrationSilver SpringMarylandUSA
| |
Collapse
|
16
|
Chatterjee A, Baker T, Rudorf M, Walt G, Stotz C, Martin A, Kinnard EN, McAlearney AS, Bosak J, Medley B, Pinkhover A, Taylor JL, Samet JH, Lunze K. Mobile treatment for opioid use disorder: Implementation of community-based, same-day medication access interventions. J Subst Use Addict Treat 2024; 159:209272. [PMID: 38128649 PMCID: PMC10947870 DOI: 10.1016/j.josat.2023.209272] [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] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Revised: 09/20/2023] [Accepted: 12/13/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Medications for Opioid Use Disorder (MOUD) are lifesaving, but <20 % of individuals in the US who could benefit receive them. As part of the NIH-supported HEALing Communities Study (HCS), coalitions in several communities in Massachusetts and Ohio implemented mobile MOUD programs to overcome barriers to MOUD receipt. We defined mobile MOUD programs as units that provide same-day access to MOUD at remote sites. We aimed to (1) document the design and organizational structure of mobile programs providing same-day or next-day MOUD, and (2) explore the barriers and facilitators to implementation as well as the successes and challenges of ongoing operation. METHODS Program staff from five programs in two states (n = 11) participated in semi-structured interviews. Two authors conducted thematic analysis of the transcripts based on the domains of the social-ecological model and the semi-structured interview guide. RESULTS Mobile MOUD units sought to improve immediate access to MOUD ("Our answer is pretty much always, 'Yes, we'll get you started right here, right now,'"), advance equity ("making sure that we have staff who speak other languages, who are on the unit and have some resources that are in different languages,"), and decrease opioid overdose deaths. Salient program characteristics included diverse staff, including staff with lived experience of substance use ("She just had that personal knowledge of where we should be going"). Mobile units offered harm reduction services, broad medical services (in particular, wound care), and connection to transportation programs and incorporated consistency in service provision and telemedicine access. Implementation facilitators included trusting relationships with partner organizations (particularly pharmacies and correctional facilities), nuanced understanding of local politics, advertising, protocol flexibility, and on-unit prescriber hours. Barriers included unclear licensing requirements, staffing shortages and competing priorities for staff, funding challenges due to inconsistency in grant funding and low reimbursement ("It's not really possible that billing in and of itself is going to be able to sustain it"), and community stigma toward addiction services generally. CONCLUSIONS Despite organizational, community, and policy barriers, participants described mobile MOUD units as an innovative way to expand access to life-saving medications, promote equity in MOUD treatment, and overcome stigma.
Collapse
Affiliation(s)
- Avik Chatterjee
- Boston University School of Medicine, Boston, MA, United States of America; Boston Medical Center, Boston, MA, United States of America.
| | - Trevor Baker
- Boston Medical Center, Boston, MA, United States of America
| | - Maria Rudorf
- Boston Medical Center, Boston, MA, United States of America
| | - Galya Walt
- Boston Medical Center, Boston, MA, United States of America
| | - Caroline Stotz
- Boston Medical Center, Boston, MA, United States of America
| | - Anna Martin
- Boston Medical Center, Boston, MA, United States of America
| | | | - Ann Scheck McAlearney
- The Ohio State University College of Medicine, Columbus, OH, United States of America
| | - Julie Bosak
- Boston Medical Center, Boston, MA, United States of America
| | - Bethany Medley
- Columbia University School of Social Work, New York, NY, United States of America
| | - Allyson Pinkhover
- Brockton Neighborhood Health Center, Brockton, MA, United States of America; Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Jessica L Taylor
- Boston University School of Medicine, Boston, MA, United States of America; Boston Medical Center, Boston, MA, United States of America
| | - Jeffrey H Samet
- Boston University School of Medicine, Boston, MA, United States of America; Boston Medical Center, Boston, MA, United States of America
| | - Karsten Lunze
- Boston University School of Medicine, Boston, MA, United States of America; Boston Medical Center, Boston, MA, United States of America
| |
Collapse
|
17
|
Senthilkumar R, Bailey A, Moner E, Parduhn T, Evans EA. Lessons Learned from Implementation of a Post-opioid Overdose Outreach Program in a Rural Massachusetts Community. Community Ment Health J 2024; 60:482-493. [PMID: 37902945 DOI: 10.1007/s10597-023-01198-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 10/03/2023] [Indexed: 11/01/2023]
Abstract
Post-overdose outreach programs can play a key role in reducing opioid overdose deaths and increasing access to healthcare services. The design and implementation of these programs, especially in rural communities, remains a gap in knowledge. We aimed to understand the lessons learned from the implementation experiences of the Community, Opportunity, Network, Navigation, Exploration, and Connection Team (CONNECT), a post-overdose outreach program based in a rural community in Massachusetts. We conducted semi-structured focus groups and interviews with 21 community partners after the first year of implementation in 2022. Participants included behavioral health, medical, public health, and public safety personnel involved in the design and implementation of CONNECT. Using a combination of thematic and rapid qualitative analysis methods, we inductively coded transcripts for salient themes. Themes were mapped onto the Health Equity Implementation Framework to better understand implementation and health-equity factors. Facilitators to implementation of this innovation included efficient inter-partner data sharing and coordination, and ability to offer numerous health services to clients to meet their needs. Key partners identified that CONNECT serves clients who use opioids, have previous involvement with the legal system, and reside in low-income areas within this rural region. Unhoused individuals and individuals who do not call 9-11 after an overdose were identified as populations of need that CONNECT was missing due to structural barriers. Partners shared how the context of this rural community came with challenges related to limited access to health services and pervasive stigma towards substance use, while it was also perceived to foster a culture of collaboration and unity among multidisciplinary key partners. Post overdose outreach programs serve clients with complex health needs. The ability to access services for these health needs is shaped by the post overdose outreach program and its key partners, and by the broader community context. As post-overdose outreach programs continue to expand as a promising strategy to address the opioid overdose crisis, there exists a need to contextualize implementation strategies to inform adaptations and develop best-practices.
Collapse
Affiliation(s)
- Rithika Senthilkumar
- Department of Health Promotion and Policy, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, MA, 01003, USA
| | - Amelia Bailey
- Department of Health Promotion and Policy, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, MA, 01003, USA.
- Department of Behavioral and Social Sciences, School of Public Health, Brown University, Box G-S121-3, Providence, RI, 02912, USA.
| | - Emily Moner
- Department of Health Promotion and Policy, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, MA, 01003, USA
| | - Taylor Parduhn
- Department of Health Promotion and Policy, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, MA, 01003, USA
| | - Elizabeth A Evans
- Department of Health Promotion and Policy, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, MA, 01003, USA
| |
Collapse
|
18
|
Fredericksen RJ, Baker R, Sibley A, Estadt AT, Colston D, Mixson LS, Walters S, Bresett J, Levander XA, Leichtling G, Davy-Mendez T, Powell M, Stopka TJ, Pho M, Feinberg J, Ezell J, Zule W, Seal D, Cooper HLF, Whitney BM, Delaney JAC, Crane HM, Tsui JI. Motivation and context of concurrent stimulant and opioid use among persons who use drugs in the rural United States: a multi-site qualitative inquiry. Harm Reduct J 2024; 21:74. [PMID: 38561753 PMCID: PMC10985853 DOI: 10.1186/s12954-024-00986-z] [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: 06/09/2023] [Accepted: 03/12/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND In recent years, stimulant use has increased among persons who use opioids in the rural U.S., leading to high rates of overdose and death. We sought to understand motivations and contexts for stimulant use among persons who use opioids in a large, geographically diverse sample of persons who use drugs (PWUD) in the rural settings. METHODS We conducted semi-structured individual interviews with PWUD at 8 U.S. sites spanning 10 states and 65 counties. Content areas included general substance use, injection drug use, changes in drug use, and harm reduction practices. We used an iterative open-coding process to comprehensively itemize and categorize content shared by participants related to concurrent use. RESULTS We interviewed 349 PWUD (64% male, mean age 36). Of those discussing current use of stimulants in the context of opioid use (n = 137, 39%), the stimulant most used was methamphetamine (78%) followed by cocaine/crack (26%). Motivations for co-use included: 1) change in drug markets and cost considerations; 2) recreational goals, e.g., seeking stronger effects after heightened opioid tolerance; 3) practical goals, such as a desire to balance or alleviate the effects of the other drug, including the use of stimulants to avoid/reverse opioid overdose, and/or control symptoms of opioid withdrawal; and 4) functional goals, such as being simultaneously energized and pain-free in order to remain productive for employment. CONCLUSION In a rural U.S. cohort of PWUD, use of both stimulants and opioids was highly prevalent. Reasons for dual use found in the rural context compared to urban studies included changes in drug availability, functional/productivity goals, and the use of methamphetamine to offset opioid overdose. Education efforts and harm reduction services and treatment, such as access to naloxone, fentanyl test strips, and accessible drug treatment for combined opioid and stimulant use, are urgently needed in the rural U.S. to reduce overdose and other adverse outcomes.
Collapse
Affiliation(s)
| | - R Baker
- Oregon Health & Science University, Portland, USA
| | - A Sibley
- University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - A T Estadt
- The Ohio State University, Colombus, USA
| | - D Colston
- University of North Carolina at Chapel Hill, Chapel Hill, USA
| | | | | | - J Bresett
- Southern Illinois University School of Medicine, Springfield, USA
| | - X A Levander
- Oregon Health & Science University, Portland, USA
| | | | - T Davy-Mendez
- University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - M Powell
- University of Washington, Seattle, USA
| | - T J Stopka
- Tufts University School of Medicine, Department of Public Health and Community Medicine, Medford, USA
| | - M Pho
- University of Chicago, Chicago, USA
| | - J Feinberg
- West Virginia University, Morgantown, USA
| | - J Ezell
- Cornell University, Ithaca, USA
| | - W Zule
- University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - D Seal
- Tulane University, New Orleans, USA
| | | | | | | | - H M Crane
- University of Washington, Seattle, USA
| | - J I Tsui
- University of Washington, Seattle, USA
| |
Collapse
|
19
|
Bovell-Ammon BJ, Yan S, Dunn D, Evans EA, Friedmann PD, Walley AY, LaRochelle MR. Prison Buprenorphine Implementation and Postrelease Opioid Use Disorder Outcomes. JAMA Netw Open 2024; 7:e242732. [PMID: 38497959 PMCID: PMC10949092 DOI: 10.1001/jamanetworkopen.2024.2732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 01/24/2024] [Indexed: 03/19/2024] Open
Abstract
Importance Agonist medications for opioid use disorder (MOUD), buprenorphine and methadone, in carceral settings might reduce the risk of postrelease opioid overdose but are uncommonly offered. In April 2019, the Massachusetts Department of Correction (MADOC), the state prison system, provided buprenorphine for incarcerated individuals in addition to previously offered injectable naltrexone. Objective To evaluate postrelease outcomes after buprenorphine implementation. Design, Setting, and Participants This cohort study with interrupted time-series analysis used linked data across multiple statewide data sets in the Massachusetts Public Health Data Warehouse stratified by sex due to differences in carceral systems. Eligible participants were individuals sentenced and released from a MADOC facility to the community. The study period for the male sample was January 2014 to November 2020; for the female sample, January 2015 to October 2019. Data were analyzed between February 2022 and January 2024. Exposure April 2019 implementation of buprenorphine during incarceration. Main Outcomes and Measures Receipt of MOUD within 4 weeks after release, opioid overdose, and all-cause mortality within 8 weeks after release, each measured as a percentage of monthly releases who experienced the outcome. Segmented linear regression analyzed changes in outcome rates after implementation. Results A total of 15 225 individuals were included. In the male sample there were 14 582 releases among 12 688 individuals (mean [SD] age, 35.0 [10.8] years; 133 Asian and Pacific Islander [0.9%], 4079 Black [28.0%], 4208 Hispanic [28.9%], 6117 White [41.9%]), a rate of 175.7 releases per month; the female sample included 3269 releases among 2537 individuals (mean [SD] age, 34.9 [9.8] years; 328 Black [10.0%], 225 Hispanic [6.9%], 2545 White [77.9%]), a rate of 56.4 releases per month. Among male participants at 20 months postimplementation, the monthly rate of postrelease buprenorphine receipt was higher than would have been expected under baseline trends (21.2% vs 10.6% of monthly releases; 18.6 additional releases per month). Naltrexone receipt was lower than expected (1.0% vs 6.0%; 8.8 fewer releases per month). Monthly rates of methadone receipt (1.4%) and opioid overdose (1.8%) were not significantly different than expected. All-cause mortality was lower than expected (1.9% vs 2.8%; 1.5 fewer deaths per month). Among female participants at 7 months postimplementation, buprenorphine receipt was higher than expected (31.6% vs 9.5%; 12.4 additional releases per month). Naltrexone receipt was lower than expected (3.4% vs 7.2%) but not statistically significantly different. Monthly rates of methadone receipt (1.1%), opioid overdose (4.8%), and all-cause mortality (1.6%) were not significantly different than expected. Conclusions and Relevance In this cohort study of state prison releases, postrelease buprenorphine receipt increased and naltrexone receipt decreased after buprenorphine became available during incarceration.
Collapse
Affiliation(s)
- Benjamin J. Bovell-Ammon
- Departments of Medicine and of Healthcare Delivery and Population Sciences, Baystate Health, Springfield, Massachusetts
- Department of Medicine, Boston Medical Center and Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
| | - Shapei Yan
- Department of Medicine, Boston Medical Center and Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
| | - Devon Dunn
- Massachusetts Department of Public Health, Boston, Massachusetts
| | - Elizabeth A. Evans
- Department of Health Promotion and Policy, University of Massachusetts Amherst School of Public Health & Health Sciences, Amherst
| | - Peter D. Friedmann
- Office of Research and Department of Medicine, University of Massachusetts Chan Medical School—Baystate and Baystate Health, Springfield
| | - Alexander Y. Walley
- Department of Medicine, Boston Medical Center and Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
| | - Marc R. LaRochelle
- Department of Medicine, Boston Medical Center and Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
| |
Collapse
|
20
|
Treitler P, Crystal S, Cantor J, Chakravarty S, Kline A, Morton C, Powell KG, Borys S, Cooperman NA. Emergency Department Peer Support Program and Patient Outcomes After Opioid Overdose. JAMA Netw Open 2024; 7:e243614. [PMID: 38526490 DOI: 10.1001/jamanetworkopen.2024.3614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/26/2024] Open
Abstract
Importance Patients treated in emergency departments (EDs) for opioid overdose often need drug treatment yet are rarely linked to services after discharge. Emergency department-based peer support is a promising approach for promoting treatment linkage, but evidence of its effectiveness is lacking. Objective To examine the association of the Opioid Overdose Recovery Program (OORP), an ED peer recovery support service, with postdischarge addiction treatment initiation, repeat overdose, and acute care utilization. Design, Setting, and Participants This intention-to-treat retrospective cohort study used 2014 to 2020 New Jersey Medicaid data for Medicaid enrollees aged 18 to 64 years who were treated for nonfatal opioid overdose from January 2015 to June 2020 at 70 New Jersey acute care hospitals. Data were analyzed from August 2022 to November 2023. Exposure Hospital OORP implementation. Main Outcomes and Measures The primary outcome was medication for opioid use disorder (MOUD) initiation within 60 days of discharge. Secondary outcomes included psychosocial treatment initiation, medically treated drug overdoses, and all-cause acute care visits after discharge. An event study design was used to compare 180-day outcomes between patients treated in OORP hospitals and those treated in non-OORP hospitals. Analyses adjusted for patient demographics, comorbidities, and prior service use and for community-level sociodemographics and drug treatment access. Results A total of 12 046 individuals were included in the study (62.0% male). Preimplementation outcome trends were similar for patients treated in OORP and non-OORP hospitals. Implementation of the OORP was associated with an increase of 0.034 (95% CI, 0.004-0.064) in the probability of 60-day MOUD initiation in the half-year after implementation, representing a 45% increase above the preimplementation mean probability of 0.075 (95% CI, 0.066-0.084). Program implementation was associated with fewer repeat medically treated overdoses 4 half-years (-0.086; 95% CI, -0.154 to -0.018) and 5 half-years (-0.106; 95% CI, -0.184 to -0.028) after implementation. Results differed slightly depending on the reference period used, and hospital-specific models showed substantial heterogeneity in program outcomes across facilities. Conclusions and Relevance In this cohort study of patients treated for opioid overdose, OORP implementation was associated with an increase in MOUD initiation and a decrease in repeat medically treated overdoses. The large variation in outcomes across hospitals suggests that treatment effects were heterogeneous and may depend on factors such as implementation success, program embeddedness, and availability of other hospital- and community-based OUD services.
Collapse
Affiliation(s)
- Peter Treitler
- Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, New Jersey
- Boston University School of Social Work, Boston, Massachusetts
| | - Stephen Crystal
- Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, New Jersey
- School of Social Work, Rutgers University, New Brunswick, New Jersey
- School of Public Health, Rutgers University, Piscataway, New Jersey
| | - Joel Cantor
- Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, New Jersey
| | - Sujoy Chakravarty
- Department of Health Sciences, Rutgers University, Camden, New Jersey
| | - Anna Kline
- Department of Psychiatry, Rutgers Robert Wood Johnson Medical School, Piscataway, New Jersey
| | - Cory Morton
- School of Social Work, Rutgers University, New Brunswick, New Jersey
- Center for Prevention Science, Rutgers University, New Brunswick, New Jersey
- Northeast and Caribbean Prevention Technology Transfer Center, Rutgers University, New Brunswick, New Jersey
| | - Kristen Gilmore Powell
- School of Social Work, Rutgers University, New Brunswick, New Jersey
- Center for Prevention Science, Rutgers University, New Brunswick, New Jersey
- Northeast and Caribbean Prevention Technology Transfer Center, Rutgers University, New Brunswick, New Jersey
| | - Suzanne Borys
- Division of Mental Health and Addiction Services, New Jersey Department of Human Services, Trenton
| | - Nina A Cooperman
- Department of Psychiatry, Rutgers Robert Wood Johnson Medical School, Piscataway, New Jersey
| |
Collapse
|
21
|
Pogue J, Lau L, Boyer J. Data-Based Opioid Risk Review in Patients with Chronic Pain: A Retrospective Chart Review. J Pain Palliat Care Pharmacother 2024; 38:74-83. [PMID: 38019479 DOI: 10.1080/15360288.2023.2288109] [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: 07/31/2023] [Accepted: 11/19/2023] [Indexed: 11/30/2023]
Abstract
A retrospective, cohort, single center, chart review was conducted to compare rates of opioid-associated serious adverse events (SAEs) in a patient cohort 6 months before and 6 months after data-based opioid risk review. The primary objective was the composite reduction in opioid-related SAEs including suicide-related events and opioid overdoses. The impact of the reviews was assessed via multivariate logistic regression and a McNemar's test to analyze difference in rates of opioid-associated SAEs. This study demonstrates that data-based opioid risk review can reduce opioid-related SAEs, opioid overdoses, and suicide-related events in the 6 months post-review. The primary outcome was not statistically significant with a p-value of 0.080. In the population that underwent opioid tapers, the hazard ratios (HR) for suicide-related events and opioid-related SAEs were 6.64 (1.09-40.53, p = 0.05) and 10.43 (0.48-226.80, p = 0.02) respectively when compared to non-tapered patients. The HR for suicide-related events and opioid-related SAEs when opioid therapy was discontinued were 9.95 (2.16-45.94, p = 0.009) and 15.64 (1.09-225.19, p = 0.001) respectively when compared to continuation of opioids. This study showed that data-based opioid risk review may reduce incidence of opioid-related SAEs in patients with chronic pain. Additionally, opioid tapers and discontinuations are significant risk factors for suicide-related events and opioid-related SAEs.
Collapse
Affiliation(s)
- Joshua Pogue
- Southern Arizona VA Healthcare System, Tucson, Arizona, USA
| | - Lily Lau
- Southern Arizona VA Healthcare System, Tucson, Arizona, USA
| | - Jeffrey Boyer
- Southern Arizona VA Healthcare System, Tucson, Arizona, USA
| |
Collapse
|
22
|
Skolnick P. Comment on: Can Intranasal Nalmefene Reduce the Number of Opioid Overdose Deaths? Clin Pharmacol Drug Dev 2024; 13:317-318. [PMID: 38289195 DOI: 10.1002/cpdd.1382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 01/01/2024] [Indexed: 03/02/2024]
|
23
|
Walker DM, Lefebvre RC, Davis A, Shiu-Yee K, Chen S, Jackson RD, Helme DW, Oga EA, Oser CB, Stotz C, Balvanz P, Asman K, Holloway J, Lewis N, Knudsen HK. Differences in perceptions of community stigma towards opioid use disorder between community substance use coalition members and the general public. J Subst Use Addict Treat 2024; 158:209276. [PMID: 38142801 PMCID: PMC10947872 DOI: 10.1016/j.josat.2023.209276] [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] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 11/01/2023] [Accepted: 12/15/2023] [Indexed: 12/26/2023]
Abstract
INTRODUCTION To examine differences in perceptions about community stigma towards individuals with opioid use disorder (OUD) between community members involved in the opioid response (i.e., coalition members) and the general public, and how community geography may moderate this relationship. METHODS This study administered identical cross-sectional surveys about perceived community opioid-related stigma to two distinct populations in 66 communities participating in the HEALing Communities Study prior to the intervention period (i.e., coalition members, November 2019-January 2020; residents, March-April 2020). Linear-mixed models compared survey responses of populations, including the moderating effect of community rural/urban location. RESULTS A total of 826 coalition members and 1131 residents completed the surveys. The study found no differences between the coalition members and residents for general perceived community opioid-related stigma. In both urban and rural communities, coalition members reported greater perceived community stigma than residents reported towards medication for opioid use disorder (MOUD), naloxone, and drug treatment as an alternative to incarceration. CONCLUSION Our findings suggest similar perceived community opioid-related stigma between coalition members and residents, yet differences emerge related to evidence-based practices (i.e., MOUD, naloxone, and drug treatment as an alternative to incarceration) to reduce opioid overdose deaths. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04111939.
Collapse
Affiliation(s)
- Daniel M Walker
- Department of Family and Community Medicine, College of Medicine, The Ohio State University, 700 Ackerman Rd, Suite 4000, Columbus, OH 43202, USA; CATALYST, The Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research, College of Medicine, The Ohio State University, 700 Ackerman Rd, Suite 4000, Columbus, OH 43202, USA.
| | - R Craig Lefebvre
- RTI International, 3040 East Cornwallis Road, Research Triangle Park, NC 22709, USA
| | - Alissa Davis
- School of Social Work, Columbia University, 1255 Amsterdam Avenue, New York, NY 10027, USA
| | - Karen Shiu-Yee
- CATALYST, The Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research, College of Medicine, The Ohio State University, 700 Ackerman Rd, Suite 4000, Columbus, OH 43202, USA
| | - Sadie Chen
- CATALYST, The Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research, College of Medicine, The Ohio State University, 700 Ackerman Rd, Suite 4000, Columbus, OH 43202, USA
| | - Rebecca D Jackson
- Center for Clinical and Translational Science and the Division of Endocrinology, Diabetes, and Metabolism, Department of Internal Medicine, The Ohio State University, 376 W. 10th Ave, Suite 205, Columbus, OH 43210, USA
| | - Donald W Helme
- Department of Communication, College of Communication and Information, University of Kentucky, 263 Blazer Dining, Lexington, KY 40506, USA
| | - Emmanuel A Oga
- RTI International, 3040 East Cornwallis Road, Research Triangle Park, NC 22709, USA
| | - Carrie B Oser
- Department of Sociology, Center for Health Equity Transformation, Center on Drug & Alcohol Research, University of Kentucky, 1531 Patterson Office Tower, Lexington, KY 40508, USA
| | - Caroline Stotz
- Boston Medical Center, One Boston Medical Center Place, Boston, MA 02118, USA
| | - Peter Balvanz
- Boston Medical Center, One Boston Medical Center Place, Boston, MA 02118, USA
| | - Kat Asman
- RTI International, 3040 East Cornwallis Road, Research Triangle Park, NC 22709, USA
| | - JaNae Holloway
- RTI International, 3040 East Cornwallis Road, Research Triangle Park, NC 22709, USA
| | - Nicky Lewis
- Department of Communication, College of Communication and Information, University of Kentucky, 263 Blazer Dining, Lexington, KY 40506, USA
| | - Hannah K Knudsen
- Department of Sociology, Center for Health Equity Transformation, Center on Drug & Alcohol Research, University of Kentucky, 1531 Patterson Office Tower, Lexington, KY 40508, USA; Department of Behavioral Science and Center on Drug and Alcohol Research, University of Kentucky, 845 Angliana Avenue, Room 204, Lexington, KY 40508, USA
| |
Collapse
|
24
|
Moullin JC, Staniland L, Uren H, Nielsen S, Lenton S. Advancing the implementation of take-home naloxone by community pharmacists: Testing the role of COM-B. Drug Alcohol Rev 2024; 43:746-759. [PMID: 38287683 DOI: 10.1111/dar.13805] [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: 05/22/2023] [Revised: 12/05/2023] [Accepted: 12/08/2023] [Indexed: 01/31/2024]
Abstract
INTRODUCTION Opioid-related overdose fatalities are rising despite the increased accessibility of take-home naloxone (THN). Targeted implementation strategies are needed to improve the distribution of naloxone. This study investigates the effectiveness of a short video targeting pharmacists that addresses implementation barriers. METHODS A pre-post, mixed methods design was adopted to examine the effect of a brief behaviour change intervention (an educational video informed by the capability, opportunity, motivation affecting behaviour (COM-B) model), on factors affecting pharmacists' implementation of THN in Western Australia. Paired samples t-tests for were used to investigate intentions, knowledge, skill, confidence, feasibility, appropriateness, acceptability, attitudes, anticipated patient reactions, social support and implementation climate. Structural equation modelling examined the associations between constructs and to test the proposed mediation of motivation on capability and opportunity affecting intentions to discuss and provide THN. RESULTS We analysed data from 102 participants. At follow-up and after all participants had viewed the video, participants had significantly improved intentions, skill, confidence, anticipated reactions, social support and perceptions that THN implementation was feasible, appropriate and acceptable. No significant differences were seen for attitudes, knowledge or implementation climate. The proposed mediation effect of motivation on the associations between opportunity and intentions and capability and intentions was not supported. DISCUSSION AND CONCLUSIONS A short video directly targeting identified implementation barriers has the ability to improve key influences in the provision of THN. Dissemination of information to community pharmacists is a challenge. Implementation strategies addressing knowledge and targeting other levels of influence on intentions and behaviour are required.
Collapse
Affiliation(s)
- Joanna C Moullin
- School of Population Health, Faculty of Health Sciences, Curtin University, Perth, Australia
- enAble Institute, Curtin University, Perth, Australia
| | | | - Hannah Uren
- School of Population Health, Faculty of Health Sciences, Curtin University, Perth, Australia
| | - Suzanne Nielsen
- Monash Addiction Research Centre, Monash University, Melbourne, Australia
| | - Simon Lenton
- enAble Institute, Curtin University, Perth, Australia
- National Drug Research Institute, Curtin University, Perth, Australia
| |
Collapse
|
25
|
Grant S, Smart R, Gordon AJ, Pacula RL, Stein BD. Expert Views on State Policies to Improve Engagement and Retention in Treatment for Opioid Use Disorder: A Qualitative Analysis of an Online Modified Delphi Process. J Addict Med 2024; 18:129-137. [PMID: 38039084 PMCID: PMC10939945 DOI: 10.1097/adm.0000000000001253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2023]
Abstract
OBJECTIVES The aim of this study was to examine expert views on the effectiveness and implementability of state policies to improve engagement and retention in treatment for opioid use disorder (OUD). METHODS We conducted a 3-round modified Delphi process using the online ExpertLens platform. Participants included 66 experts on OUD treatment policies. Experts commented on 14 hypothetical state policies targeting treatment engagement and quality of care. Using the GRADE Evidence-to-Decision framework, we conducted reflexive thematic analysis to develop patterns of meaning from the dataset. RESULTS Only policies for providing continued access to evidence-based treatment for highly at-risk populations, settings, and periods were seen as effective in meaningfully reducing population-level opioid-related overdose mortality. Experts commented that, although the general public increasingly supports policies expanding medications for OUD and evidence-based care, ongoing stigma about OUD encourages public acceptance of punitive and paternalistic policies. Experts viewed all policies as at least moderately feasible given the current infrastructure and resources, with affordability reliant on long-term cost savings from reduced opioid-related harms. Equitability depended on whether experts perceived a policy as inherently equitable in its design as well as concerns about the potential for inequitable implementation due to structural oppression and interpersonal biases in criminal-legal, healthcare, and other systems. CONCLUSIONS Experts believe that supportive (rather than punitive) policies improve engagement and retention in OUD treatment. States could prioritize implementing supportive policies that are patient-centered and take a harm-reduction approach to enhance medications for OUD access and utilization. States could consider deimplementing punitive policies that are coercive, take an abstinence-only approach, and use punitive and restrictive measures.
Collapse
Affiliation(s)
| | | | - Adam J. Gordon
- Program for Addiction Research, Clinical Care, Knowledge, and Advocacy (PARCKA), University of Utah School of Medicine
- Informatics, Decision-Enhancement, and Analytic Sciences (IDEAS) Center of Innovation, VA Salt Lake City Health Care System
| | | | | |
Collapse
|
26
|
Dickson-Gomez J, Krechel S, Ohlrich J, Montaque HDG, Weeks M, Li J, Havens J, Spector A. "They make it too hard and too many hoops to jump": system and organizational barriers to drug treatment during epidemic rates of opioid overdose. Harm Reduct J 2024; 21:52. [PMID: 38413972 PMCID: PMC10900746 DOI: 10.1186/s12954-024-00964-5] [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: 03/17/2023] [Accepted: 02/19/2024] [Indexed: 02/29/2024] Open
Abstract
INTRODUCTION The United States is currently facing an opioid overdose crisis. Research suggests that multiple interventions are needed to reduce overdose deaths including increasing access and retention to medications to treat opioid use disorders (MOUD, i.e., methadone, buprenorphine, and naltrexone) and increasing the distribution and use of naloxone, a medication that can reverse the respiratory depression that occurs during opioid overdoses. However, barriers to MOUD initiation and retention persist and discontinuations of MOUD carry a heightened risk of overdose. Many times, MOUD is not sought as a first line of treatment by people with opioid use disorder (OUD), many of whom seek treatment from medically managed withdrawal (detox) programs. Among those who do initiate MOUD, retention is generally low. The present study examines the treatment experiences of people who use opioids in three states, Connecticut, Kentucky, and Wisconsin. METHODS We conducted in-depth interviews with people who use opioids in a rural, urban, and suburban area of three states: Connecticut, Kentucky and Wisconsin. Data analysis was collaborative and key themes were identified through multiple readings, coding of transcripts and discussion with all research team members. RESULTS Results reveal a number of systemic issues that reduce the likelihood that people initiate and are retained on MOUD including the ubiquity of detox as a first step in drug treatment, abstinence requirements and requiring patients to attend group treatment. MOUD-related stigma was a significant factor in the kinds of treatment participants chose and their experiences in treatment. CONCLUSIONS Interventions to reduce MOUD stigma are needed to encourage MOUD as a first course of treatment. Eliminating abstinence-based rules for MOUD treatment may improve treatment retention and decrease overdose risk.
Collapse
|
27
|
Frank ND, Banta-Green CJ, Guthrie BL, Kingston S, Tinsley J, Whiteside L, Glick SN. Emergency Room Utilization and Methamphetamine Overdose Symptoms Among Syringe Services Program Participants in Washington State. Subst Use Misuse 2024; 59:1012-1019. [PMID: 38369494 DOI: 10.1080/10826084.2024.2317148] [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: 02/20/2024]
Abstract
BACKGROUND Methamphetamine overdose can cause severe psychological and physical health issues including psychosis, heart attack, and death. People who use methamphetamine (PWUM) who experience methamphetamine overdose symptoms (MOS) are advised to seek emergency healthcare; however, factors related to seeking care are not well characterized. METHODS This study used data from the 2021 Washington State Syringe Services Program (SSP) Health Survey, a cross-sectional survey administered to participants at 21 SSPs in Washington (N = 955). Participants answered questions related to substance use including emergency department/room (ER) utilization for methamphetamine use and whether they experienced psychological and physical MOS. Using Poisson regression, we assessed the association between ER utilization for methamphetamine use, non-fatal opioid overdose, and other key covariates among PWUM who experienced MOS. RESULTS Methamphetamine use in the last three months was reported by 86% of participants. Among PWUM, 31% reported psychological MOS, 19% reported physical MOS, and 37% reported ≥1 MOS in the prior three months. Non-fatal opioid overdose (adjusted prevalence ratio [APR] = 2.04, 95% CI = 1.38-3.03), main drug of goofball (heroin and methamphetamine combined) (APR = 1.98, 95% CI = 1.34-2.92) and recent blood infection/sepsis (APR = 2.07, 95% CI = 1.24-3.46) were associated with ER utilization for MOS. CONCLUSION Among people who use SSPs in Washington State, methamphetamine use remains high, and MOS are common. Recent non-fatal opioid overdose was positively associated with ER utilization for methamphetamine use among PWUM who experienced MOS. Patients in the ER for MOS should be screened for opioid use disorder and linked with harm reduction supplies like naloxone and medications for opioid use disorder.
Collapse
Affiliation(s)
- Noah D Frank
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington, USA
| | - Caleb J Banta-Green
- Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle, Washington, USA
- Addictions, Drug & Alcohol Institute, Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, Washington, USA
| | - Brandon L Guthrie
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington, USA
| | - Susan Kingston
- Addictions, Drug & Alcohol Institute, Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, Washington, USA
| | - Joe Tinsley
- HIV/STI/HCV Program, Public Health-Seattle & King County, Seattle, Washington, USA
| | - Lauren Whiteside
- Department of Emergency Medicine, School of Medicine, University of Washington, Seattle, Washington, USA
| | - Sara N Glick
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington, USA
- HIV/STI/HCV Program, Public Health-Seattle & King County, Seattle, Washington, USA
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, Washington, USA
| |
Collapse
|
28
|
Moffitt T, Fallin-Bennett A, Fanucchi L, Walsh SL, Cook C, Oller D, Ross A, Gallivan M, Lauckner J, Byard J, Wheeler-Crum P, Lofwall MR. The development of a recovery coaching training curriculum to facilitate linkage to and increase retention on medications for opioid use disorder. Front Public Health 2024; 12:1334850. [PMID: 38425462 PMCID: PMC10903364 DOI: 10.3389/fpubh.2024.1334850] [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: 11/07/2023] [Accepted: 01/23/2024] [Indexed: 03/02/2024] Open
Abstract
Introduction Medication treatment for opioid use disorder (MOUD) decreases opioid overdose risk and is the standard of care for persons with opioid use disorder (OUD). Recovery coach (RC)-led programs and associated training curriculums to improve outcomes around MOUD are limited. We describe our comprehensive training curriculum including instruction and pedagogy for novel RC-led MOUD linkage and retention programs and report on its feasibility. Methods–pedagogy and training development The Kentucky HEALing (Helping to End Addiction Long-termSM) Communities Study (HCS) created the Linkage and Retention RC Programs with a local recovery community organization, Voices of Hope-Lexington. RCs worked to reduce participant barriers to entering or continuing MOUD, destigmatize and educate on MOUD and harm reduction (e.g., safe injection practices), increase recovery capital, and provide opioid overdose education with naloxone distribution (OEND). An extensive hybrid (in-person and online, both synchronous and asynchronous), inclusive learning-focused curriculum to support the programs (e.g., motivational interviewing sessions, role plays, MOUD competency assessment, etc.,) was created to ensure RCs developed the necessary skills and could demonstrate competency before deployment in the field. The curriculum, pedagogy, learning environment, and numbers of RCs trained and community venues receiving a trained RC are reported, along with interviews from three RCs about the training program experience. Results The curriculum provides approximately 150 h of training to RCs. From December 2020 to February 2023, 93 RCs and 16 supervisors completed the training program; two were unable to pass a final competency check. RCs were deployed at 45 agencies in eight Kentucky HCS counties. Most agencies (72%) sustained RC services after the study period ended through other funding sources. RCs interviewed reported that the training helped them better explain and dispel myths around MOUD. Conclusion Our novel training and MOUD programs met a current unmet need for the RC workforce and for community agencies. We were able to train and deploy RCs successfully in these new programs aimed at saving lives through improving MOUD linkage and retention. This paper addresses a need to enhance the training requirements around MOUD for peer support specialists.
Collapse
Affiliation(s)
- Trevor Moffitt
- University of Kentucky, Substance Use Priority Research Area, Lexington, KY, United States
| | - Amanda Fallin-Bennett
- College of Nursing, University of Kentucky, Lexington, KY, United States
- Voices of Hope, Lexington, KY, United States
| | - Laura Fanucchi
- College of Medicine, Center on Drug and Alcohol Research, University of Kentucky, Lexington, KY, United States
| | - Sharon L. Walsh
- College of Medicine, Center on Drug and Alcohol Research, University of Kentucky, Lexington, KY, United States
- Department of Behavioral Science, College of Medicine, University of Kentucky, Lexington, KY, United States
| | - Christopher Cook
- University of Kentucky, Substance Use Priority Research Area, Lexington, KY, United States
| | - Devin Oller
- College of Medicine, University of Kentucky, Lexington, KY, United States
| | - Anna Ross
- Voices of Hope, Lexington, KY, United States
| | - Molly Gallivan
- University of Kentucky, Substance Use Priority Research Area, Lexington, KY, United States
| | - John Lauckner
- University of Kentucky, Substance Use Priority Research Area, Lexington, KY, United States
| | - Jeremy Byard
- Arthur Street Hotel, Louisville, KY, United States
| | | | - Michelle R. Lofwall
- College of Medicine, Center on Drug and Alcohol Research, University of Kentucky, Lexington, KY, United States
- Department of Behavioral Science, College of Medicine, University of Kentucky, Lexington, KY, United States
| |
Collapse
|
29
|
Payne ER, Stancliff S, Rowe K, Christie JA, Dailey MW. Comparison of Administration of 8-Milligram and 4-Milligram Intranasal Naloxone by Law Enforcement During Response to Suspected Opioid Overdose - New York, March 2022-August 2023. MMWR Morb Mortal Wkly Rep 2024; 73:110-113. [PMID: 38329911 PMCID: PMC10861201 DOI: 10.15585/mmwr.mm7305a4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/10/2024]
Abstract
In 2021, an 8-mg intranasal naloxone product was approved by the Food and Drug Administration; however, no studies have examined outcomes among persons who receive the 8-mg naloxone product and those who receive the usual 4-mg product. During March 2022-August 2023, New York State Department of Health (NYSDOH) supplied some New York State Police (NYSP) troops with 8-mg intranasal naloxone; other troops continued to receive 4-mg intranasal naloxone to treat suspected opioid overdose. NYSP submitted detailed reports to NYSDOH when naloxone was administered. No significant differences were observed in survival, mean number of naloxone doses administered, prevalence of most postnaloxone signs and symptoms, postnaloxone anger or combativeness, or hospital transport refusal among 4-mg and 8-mg intranasal naloxone recipients; however, persons who received the 8-mg intranasal naloxone product had 2.51 times the risk for opioid withdrawal signs and symptoms, including vomiting, than did those who received the 4-mg intranasal naloxone product (95% CI = 1.51-4.18). This initial study suggests no benefits to law enforcement administration of higher-dose naloxone were identified; more research is needed to guide public health agencies in considering whether 8-mg intranasal naloxone confers additional benefits for community organizations.
Collapse
|
30
|
Stopka TJ, Babineau DC, Gibson EB, Knott CE, Cheng DM, Villani J, Wai JM, Blevins D, David JL, Goddard-Eckrich DA, Lofwall MR, Massatti R, DeFiore-Hyrmer J, Lyons MS, Fanucchi LC, Harris DR, Talbert J, Hammerslag L, Oller D, Balise RR, Feaster DJ, Soares W, Zarkin GA, Glasgow L, Oga E, McCarthy J, D’Costa L, Chahine R, Gomori S, Dalvi N, Shrestha S, Garner C, Shadwick A, Salsberry P, Konstan MW, Freisthler B, Winhusen J, El-Bassel N, Samet JH, Walsh SL. Impact of the Communities That HEAL Intervention on Buprenorphine-Waivered Practitioners and Buprenorphine Prescribing: A Prespecified Secondary Analysis of the HCS Randomized Clinical Trial. JAMA Netw Open 2024; 7:e240132. [PMID: 38386322 PMCID: PMC10884876 DOI: 10.1001/jamanetworkopen.2024.0132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 01/03/2024] [Indexed: 02/23/2024] Open
Abstract
Importance Buprenorphine significantly reduces opioid-related overdose mortality. From 2002 to 2022, the Drug Addiction Treatment Act of 2000 (DATA 2000) required qualified practitioners to receive a waiver from the Drug Enforcement Agency to prescribe buprenorphine for treatment of opioid use disorder. During this period, waiver uptake among practitioners was modest; subsequent changes need to be examined. Objective To determine whether the Communities That HEAL (CTH) intervention increased the rate of practitioners with DATA 2000 waivers and buprenorphine prescribing. Design, Setting, and Participants This prespecified secondary analysis of the HEALing Communities Study, a multisite, 2-arm, parallel, community-level, cluster randomized, open, wait-list-controlled comparison clinical trial was designed to assess the effectiveness of the CTH intervention and was conducted between January 1, 2020, to December 31, 2023, in 67 communities in Kentucky, Massachusetts, New York, and Ohio, accounting for approximately 8.2 million adults. The participants in this trial were communities consisting of counties (n = 48) and municipalities (n = 19). Trial arm randomization was conducted using a covariate constrained randomization procedure stratified by state. Each state was balanced by community characteristics including urban/rural classification, fatal opioid overdose rate, and community population. Thirty-four communities were randomized to the intervention and 33 to wait-list control arms. Data analysis was conducted between March 20 and September 29, 2023, with a focus on the comparison period from July 1, 2021, to June 30, 2022. Intervention Waiver trainings and other educational trainings were offered or supported by the HEALing Communities Study research sites in each state to help build practitioner capacity. Main Outcomes and Measures The rate of practitioners with a DATA 2000 waiver (overall, and stratified by 30-, 100-, and 275-patient limits) per 100 000 adult residents aged 18 years or older during July 1, 2021, to June 30, 2022, were compared between the intervention and wait-list control communities. The rate of buprenorphine prescribing among those waivered practitioners was also compared between the intervention and wait-list control communities. Intention-to-treat and per-protocol analyses were performed. Results A total of 8 166 963 individuals aged 18 years or older were residents of the 67 communities studied. There was no evidence of an effect of the CTH intervention on the adjusted rate of practitioners with a DATA 2000 waiver (adjusted relative rate [ARR], 1.04; 95% CI, 0.94-1.14) or the adjusted rate of practitioners with a DATA 2000 waiver who actively prescribed buprenorphine (ARR, 0.97; 95% CI, 0.86-1.10). Conclusions and Relevance In this randomized clinical trial, the CTH intervention was not associated with increases in the rate of practitioners with a DATA 2000 waiver or buprenorphine prescribing among those waivered practitioners. Supporting practitioners to prescribe buprenorphine remains a critical yet challenging step in the continuum of care to treat opioid use disorder. Trial Registration ClinicalTrials.gov Identifier: NCT04111939.
Collapse
Affiliation(s)
- Thomas J. Stopka
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, Massachusetts
| | | | - Erin B. Gibson
- Department of Medicine, Boston Medical Center, Boston, Massachusetts
| | - Charles E. Knott
- Research Triangle Institute, Research Triangle Park, North Carolina
| | - Debbie M. Cheng
- Boston University School of Public Health, Boston, Massachusetts
| | - Jennifer Villani
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, Maryland
| | - Jonathan M. Wai
- Department of Psychiatry, Columbia University; Division on Substance Use Disorders, New York State Psychiatric Institute, New York
| | - Derek Blevins
- Department of Psychiatry, Columbia University; Division on Substance Use Disorders, New York State Psychiatric Institute, New York
| | - James L. David
- Department of Psychiatry, Columbia University; Division on Substance Use Disorders, New York State Psychiatric Institute, New York
| | - Dawn A. Goddard-Eckrich
- Department of Psychiatry, Columbia University; Division on Substance Use Disorders, New York State Psychiatric Institute, New York
| | - Michelle R. Lofwall
- College of Medicine, University of Kentucky Center on Drug and Alcohol Research, Lexington
| | - Richard Massatti
- Ohio Department of Mental Health and Addiction Services, Columbus
| | | | | | - Laura C. Fanucchi
- College of Medicine, University of Kentucky Center on Drug and Alcohol Research, Lexington
| | | | | | - Lindsey Hammerslag
- College of Medicine, University of Kentucky Center on Drug and Alcohol Research, Lexington
| | - Devin Oller
- College of Medicine, University of Kentucky Center on Drug and Alcohol Research, Lexington
| | - Raymond R. Balise
- Department of Public Health Sciences, University of Miami, Miami, Florida
| | - Daniel J. Feaster
- Department of Public Health Sciences, University of Miami, Miami, Florida
| | - William Soares
- UMass Chan Medical School–Baystate, Springfield, Massachusetts
| | - Gary A. Zarkin
- Research Triangle Institute, Research Triangle Park, North Carolina
| | - LaShawn Glasgow
- Research Triangle Institute, Research Triangle Park, North Carolina
| | - Emmanuel Oga
- Research Triangle Institute, Research Triangle Park, North Carolina
| | - John McCarthy
- Research Triangle Institute, Research Triangle Park, North Carolina
| | - Lauren D’Costa
- Research Triangle Institute, Research Triangle Park, North Carolina
| | - Rouba Chahine
- Research Triangle Institute, Research Triangle Park, North Carolina
| | - Steve Gomori
- Research Triangle Institute, Research Triangle Park, North Carolina
| | - Netrali Dalvi
- Office of Prescription Monitoring and Drug Control, Massachusetts Department of Public Health, Boston
| | - Shikhar Shrestha
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, Massachusetts
| | | | - Aimee Shadwick
- RecoveryOhio, Office of Ohio Governor Mike DeWine, Columbus
| | - Pamela Salsberry
- Health Behavior and Health Promotion, Ohio State University, Columbus
| | | | | | - John Winhusen
- University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Nabila El-Bassel
- Department of Psychiatry, Columbia University; Division on Substance Use Disorders, New York State Psychiatric Institute, New York
| | - Jeffrey H. Samet
- Department of Medicine, Boston Medical Center, Boston, Massachusetts
- Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine and Boston Medical Center, Boston, Massachusetts
| | - Sharon L. Walsh
- College of Medicine, University of Kentucky Center on Drug and Alcohol Research, Lexington
| |
Collapse
|
31
|
Arakkal AT, Polgreen LA, Chapman CG, Simmering JE, Cavanaugh JE, Polgreen PM, Miller AC. Association between household opioid prescriptions and risk for overdose among family members not prescribed opioids. Pharmacotherapy 2024; 44:110-121. [PMID: 37926925 DOI: 10.1002/phar.2891] [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: 07/14/2023] [Revised: 09/08/2023] [Accepted: 09/09/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND Prescription opioids have contributed to the rise in opioid-related overdoses and deaths. The presence of opioids within households may increase the risk of overdose among family members who were not prescribed an opioid themselves. Larger quantities of opioids may further increase risk. OBJECTIVES To determine the risk of opioid overdose among individuals who were not prescribed an opioid but were exposed to opioids prescribed to other family members in the household, and evaluate the risk in relation to the total morphine milligram equivalents (MMEs) present in the household. METHODS We conducted a cohort study using a large database of commercial insurance claims from 2001 to 2021. For inclusion in the cohort, we identified individuals not prescribed an opioid in the prior 90 days from households with two or more family members, and determined the total MMEs prescribed to other family members. Individuals were stratified into monthly enrollment strata defined by household opioid exposure and other confounders. A generalized linear model was used to estimate incidence rate ratios (IRRs) for overdose. RESULTS Overall, the incidence of overdose among enrollees in households where a family member was prescribed an opioid was 1.73 (95% confidence interval [CI]: 1.67-1.78) times greater than households without opioid prescriptions. The risk of overdose increased continuously with the level of potential MMEs in the household from an IRR of 1.23 (95% CI: 1.16-1.32) for 1-100 MMEs to 4.67 (95% CI: 4.18-5.22) for >12,000 MMEs. The risk of overdose associated with household opioid exposure was greatest for ages 1-2 years (IRR: 3.46 [95% CI: 2.98-4.01]) and 3-5 years (IRR: 3.31 [95% CI: 2.75-3.99]). CONCLUSIONS The presence of opioids in a household significantly increases the risk of overdose among other family members who were not prescribed an opioid. Higher levels of MMEs, either in terms of opioid strength or quantity, were associated with increased levels of risk. Risk estimates may reflect accidental poisonings among younger family members.
Collapse
Affiliation(s)
- Alan T Arakkal
- Department of Biostatistics, University of Iowa, Iowa City, Iowa, USA
| | | | - Cole G Chapman
- College of Pharmacy, University of Iowa, Iowa City, Iowa, USA
| | - Jacob E Simmering
- Department of Internal Medicine, University of Iowa, Iowa City, Iowa, USA
| | | | - Philip M Polgreen
- Department of Internal Medicine, University of Iowa, Iowa City, Iowa, USA
| | - Aaron C Miller
- Department of Internal Medicine, University of Iowa, Iowa City, Iowa, USA
| |
Collapse
|
32
|
Maguire DR, France CP. Daily methocinnamox treatment dose-dependently attenuates fentanyl self-administration in rhesus monkeys. Neuropharmacology 2024; 243:109777. [PMID: 37944894 DOI: 10.1016/j.neuropharm.2023.109777] [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: 08/11/2023] [Revised: 09/26/2023] [Accepted: 10/22/2023] [Indexed: 11/12/2023]
Abstract
Opioid use disorder and opioid overdose continue to be significant public health challenges despite the availability of effective treatments. Methocinnamox (MCAM) is a novel, long-acting opioid receptor antagonist that might be an effective treatment for opioid use disorder (i.e., preventing relapse and overdose). In nonhuman primates, MCAM selectively blocks the positive reinforcing effects of mu opioid receptor agonists, including heroin, fentanyl, and its ultra-potent analogs (e.g., carfentanil) with a single administration of MCAM being effective for up to two weeks. Because treatment of opioid use disorder would involve repeated administration of a medication, MCAM was studied in rhesus monkeys (3 males and 2 females) responding under a fixed-ratio self-administration procedure for a range of doses of fentanyl (0.000032-0.1 mg/kg/infusion). The fentanyl self-administration dose-effect curve was determined before and during treatment with progressively increasing daily doses of MCAM (0.001-0.1 mg/kg) given subcutaneously 1 h before the session. MCAM dose-dependently shifted the fentanyl dose-effect curve rightward and then, at larger doses, downward. The largest treatment dose of MCAM (0.1 mg/kg/day) shifted the curve more than 120-fold rightward with monkeys receiving doses much larger than the likely lethal dose of fentanyl with no adverse effect or observable change in behavior. This study demonstrates that MCAM reliably and dose-dependently decreases fentanyl self-administration and prevents opioid overdose, with no evidence of adverse effects over a broad dose range, further supporting the potential therapeutic utility of this novel antagonist.
Collapse
Affiliation(s)
- David R Maguire
- Department of Pharmacology, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX, 78229, USA; Addiction Research, Treatment & Training Center of Excellence, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX, 78229, USA
| | - Charles P France
- Department of Pharmacology, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX, 78229, USA; Addiction Research, Treatment & Training Center of Excellence, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX, 78229, USA; Department of Psychiatry, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX, 78229, USA.
| |
Collapse
|
33
|
Cole S, Olive MF, Wirkus S. The dynamics of heroin and illicit opioid use disorder, casual use, treatment, and recovery: A mathematical modeling analysis. Math Biosci Eng 2024; 21:3165-3206. [PMID: 38454724 DOI: 10.3934/mbe.2024141] [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] [Subscribe] [Scholar Register] [Indexed: 03/09/2024]
Abstract
A leading crisis in the United States is the opioid use disorder (OUD) epidemic. Opioid overdose deaths have been increasing, with over 100,000 deaths due to overdose from April 2020 to April 2021. This paper presents a mathematical model to address illicit OUD (IOUD), initiation, casual use, treatment, relapse, recovery, and opioid overdose deaths within an epidemiological framework. Within this model, individuals remain in the recovery class unless they relapse back to use and due to the limited availability of specialty treatment facilities for individuals with OUD, a saturation treatment function was incorporated. Additionally, a casual user class and its corresponding specialty treatment class were incorporated. We use both heroin and all-illicit opioids datasets to find parameter estimates for our models. Bistability of equilibrium solutions was found for realistic parameter values for the heroin-only dataset. This result implies that it would be beneficial to increase the availability of treatment. An alarming effect was discovered about the high overdose death rate: by 2046, the disorder-free equilibrium would be the only stable equilibrium. This consequence is concerning because it means the epidemic would end due to high overdose death rates. The IOUD model with a casual user class, its sensitivity results, and the comparison of parameters for both datasets, showed the importance of not overlooking the influence that casual users have in driving the all-illicit opioid epidemic. Casual users stay in the casual user class longer and are not going to treatment as quickly as the users of the heroin epidemic. Another result was that the users of the all-illicit opioids were going to the recovered class by means other than specialty treatment. However, the change in the relapse rate has more of an influence for those individuals than in the heroin-only epidemic. The results above from analyzing this model may inform health and policy officials, leading to more effective treatment options and prevention efforts.
Collapse
Affiliation(s)
- Sandra Cole
- Arizona State University, School of Mathematical and Natural Sciences, Glendale, AZ, USA
| | - M Foster Olive
- Arizona State University, Department of Psychology, Tempe, AZ, USA
| | - Stephen Wirkus
- Arizona State University, School of Mathematical and Natural Sciences, Glendale, AZ, USA
- The University of Texas at San Antonio, Department of Mathematics, San Antonio, TX, USA
| |
Collapse
|
34
|
Graham SS, Shifflet S, Amjad M, Claborn K. An interpretable machine learning framework for opioid overdose surveillance from emergency medical services records. PLoS One 2024; 19:e0292170. [PMID: 38289927 PMCID: PMC10826931 DOI: 10.1371/journal.pone.0292170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 09/14/2023] [Indexed: 02/01/2024] Open
Abstract
The goal of this study is to develop and validate a lightweight, interpretable machine learning (ML) classifier to identify opioid overdoses in emergency medical services (EMS) records. We conducted a comparative assessment of three feature engineering approaches designed for use with unstructured narrative data. Opioid overdose annotations were provided by two harm reduction paramedics and two supporting annotators trained to reliably match expert annotations. Candidate feature engineering techniques included term frequency-inverse document frequency (TF-IDF), a highly performant approach to concept vectorization, and a custom approach based on the count of empirically-identified keywords. Each feature set was trained using four model architectures: generalized linear model (GLM), Naïve Bayes, neural network, and Extreme Gradient Boost (XGBoost). Ensembles of trained models were also evaluated. The custom feature models were also assessed for variable importance to aid interpretation. Models trained using TF-IDF feature engineering ranged from AUROC = 0.59 (95% CI: 0.53-0.66) for the Naïve Bayes to AUROC = 0.76 (95% CI: 0.71-0.81) for the neural network. Models trained using concept vectorization features ranged from AUROC = 0.83 (95% 0.78-0.88)for the Naïve Bayes to AUROC = 0.89 (95% CI: 0.85-0.94) for the ensemble. Models trained using custom features were the most performant, with benchmarks ranging from AUROC = 0.92 (95% CI: 0.88-0.95) with the GLM to 0.93 (95% CI: 0.90-0.96) for the ensemble. The custom features model achieved positive predictive values (PPV) ranging for 80 to 100%, which represent substantial improvements over previously published EMS encounter opioid overdose classifiers. The application of this approach to county EMS data can productively inform local and targeted harm reduction initiatives.
Collapse
Affiliation(s)
- S. Scott Graham
- Department of Rhetoric & Writing, Center for Health Communication, University of Texas at Austin, Austin, TX, United States of Amedrica
- Addiction Research Institute, University of Texas at Austin, Austin, TX, United States of Amedrica
| | - Savannah Shifflet
- Addiction Research Institute, University of Texas at Austin, Austin, TX, United States of Amedrica
| | - Maaz Amjad
- Addiction Research Institute, University of Texas at Austin, Austin, TX, United States of Amedrica
| | - Kasey Claborn
- Addiction Research Institute, University of Texas at Austin, Austin, TX, United States of Amedrica
- Steve Hicks School of Social Work, University of Texas at Austin, Austin, TX, United States of Amedrica
| |
Collapse
|
35
|
O'Grady MA, Elkington KS, Robson G, Achebe IY, Williams AR, Cohall AT, Cohall R, Christofferson M, Garcia A, Ramsey KS, Lincourt P, Tross S. Referral to and engagement in substance use disorder treatment within opioid intervention courts in New York: a qualitative study of implementation barriers and facilitators. Subst Abuse Treat Prev Policy 2024; 19:12. [PMID: 38287329 PMCID: PMC10826099 DOI: 10.1186/s13011-024-00593-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] [Received: 08/21/2023] [Accepted: 01/09/2024] [Indexed: 01/31/2024] Open
Abstract
BACKGROUND People with opioid use disorder (OUD) are frequently in contact with the court system and have markedly higher rates of fatal opioid overdose. Opioid intervention courts (OIC) were developed to address increasing rates of opioid overdose among court defendants by engaging court staff in identification of treatment need and referral for opioid-related services and building collaborations between the court and OUD treatment systems. The study goal was to understand implementation barriers and facilitators in referring and engaging OIC clients in OUD treatment. METHODS Semi-structured interviews were conducted with OIC stakeholders (n = 46) in 10 New York counties in the United States, including court coordinators, court case managers, and substance use disorder treatment clinic counselors, administrators, and peers. Interviews were recorded and transcribed and thematic analysis was conducted, guided by the Exploration, Preparation, Implementation, Sustainment (EPIS) framework, employing both inductive and deductive coding. RESULTS Results were conceptualized using EPIS inner (i.e., courts) and outer (i.e., OUD treatment providers) implementation contexts and bridging factors that impacted referral and engagement to OUD treatment from the OIC. Inner factors that facilitated OIC implementation included OIC philosophy (e.g., non-punitive, access-oriented), court organizational structure (e.g., strong court staff connectedness), and OIC court staff and client characteristics (e.g., positive medications for OUD [MOUD] attitudes). The latter two also served as barriers (e.g., lack of formalized procedures; stigma toward MOUD). Two outer context entities impacted OIC implementation as both barriers and facilitators: substance use disorder treatment programs (e.g., attitudes toward the OIC and MOUD; operational characteristics) and community environments (e.g., attitudes toward the opioid epidemic). The COVID-19 pandemic and bail reform were macro-outer context factors that negatively impacted OIC implementation. Facilitating bridging factors included staffing practices that bridged court and treatment systems (e.g., peers); barriers included communication and cultural differences between systems (e.g., differing expectations about OIC client success). CONCLUSIONS This study identified key barriers and facilitators that OICs may consider as this model expands in the United States. Referral to and engagement in OUD treatment within the OIC context requires ongoing efforts to bridge the treatment and court systems, and reduce stigma around MOUD.
Collapse
Affiliation(s)
- Megan A O'Grady
- Department of Public Health Sciences, University of Connecticut School of Medicine, 263 Farmington Ave, Farmington, CT, 06030, USA.
| | - Katherine S Elkington
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, Columbia University, New York, NY, USA
- Center for Behavioral Health and Youth Justice, Columbia University, New York Psychiatric Institute, New York, NY, USA
| | - Gail Robson
- Callen-Lorde Community Health Center, New York, NY, USA
| | - Ikenna Y Achebe
- Center for Behavioral Health and Youth Justice, Columbia University, New York Psychiatric Institute, New York, NY, USA
| | - Arthur Robin Williams
- Division on Substance Use Disorders, New York State Psychiatric Institute, New York, NY, USA
| | - Alwyn T Cohall
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Renee Cohall
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | | | | | - Kelly S Ramsey
- New York State Office of Addiction Services and Supports, Albany, NY, USA
| | - Pat Lincourt
- New York State Office of Addiction Services and Supports, Albany, NY, USA
| | - Susan Tross
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, Columbia University, New York, NY, USA
- Division on Substance Use Disorders, New York State Psychiatric Institute, New York, NY, USA
| |
Collapse
|
36
|
Romano IG, Core SB, Lee NR, Mowry C, Van Rompay KKA, Huang Y, Chackerian B, Frietze KM. A bacteriophage virus-like particle vaccine against oxycodone elicits high-titer and long-lasting antibodies that sequester drug in the blood. Vaccine 2024; 42:471-480. [PMID: 38160131 PMCID: PMC10872394 DOI: 10.1016/j.vaccine.2023.12.077] [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: 10/25/2023] [Revised: 12/21/2023] [Accepted: 12/23/2023] [Indexed: 01/03/2024]
Abstract
Opioid use disorder (OUD) and opioid overdoses are public health emergencies. In 2021, 80,000 opioid overdose associated deaths were reported in the United States. Despite the availability of treatment strategies, including medications for opioid use disorder (MOUD) and naloxone, opioid overdoses continue to increase at an alarming rate. Opioid vaccines are a novel approach to combat the growing crisis with several candidates recently entering human clinical trials. In this study, we investigated Qβ bacteriophage virus-like particles (VLPs) as a vaccine platform for immunogenic display of oxycodone. A derivative of oxycodone was conjugated to pre-formed Qβ VLPs using a sulfhydryl-amine reactive heterobifunctional crosslinker with high loading of oxycodone. In mice, intramuscular immunization with Qβ-oxycodone elicited high-titer, high-avidity and long-lasting antibody responses. Qβ-oxycodone was also immunogenic after storage at ambient room temperature for over two weeks, demonstrating that the vaccine is highly thermostable. In mice, immunization with Qβ-oxycodone elicited antibodies that sequester oxycodone in the serum, an important mechanism for preventing the adverse effects of opioid activity. Finally, Qβ-oxycodone is immunogenic in nonhuman primates, eliciting serum oxycodone antibodies after intramuscular immunization of rhesus macaques. These data establish Qβ-oxycodone as a promising opioid vaccine candidate.
Collapse
Affiliation(s)
- Isabella G Romano
- Department of Molecular Genetics and Microbiology, School of Medicine, University of New Mexico, MSC 08-4660, 1 University of New Mexico, Albuquerque, NM 87131, USA
| | - Susan B Core
- Department of Molecular Genetics and Microbiology, School of Medicine, University of New Mexico, MSC 08-4660, 1 University of New Mexico, Albuquerque, NM 87131, USA
| | - Naomi R Lee
- Department of Chemistry and Biochemistry, Northern Arizona University, 700 S. Osborne Drive, P.O. Box 5698, Flagstaff, AZ 86011, USA
| | - Curtis Mowry
- Department of Chemistry and Chemical Biology, University of New Mexico, MSC 03-2060, 1 University of New Mexico, Albuquerque, NM 87131, USA
| | - Koen K A Van Rompay
- California National Primate Research Center, University of California - Davis, One Shields Avenue, Davis, CA 95616, USA
| | - Yumei Huang
- CellMosaic, Inc, 10A Roessler Road, Woburn, MA 01801, USA
| | - Bryce Chackerian
- Department of Molecular Genetics and Microbiology, School of Medicine, University of New Mexico, MSC 08-4660, 1 University of New Mexico, Albuquerque, NM 87131, USA
| | - Kathryn M Frietze
- Department of Molecular Genetics and Microbiology, School of Medicine, University of New Mexico, MSC 08-4660, 1 University of New Mexico, Albuquerque, NM 87131, USA.
| |
Collapse
|
37
|
Aquizerate A, Rousselet M, Cochard A, Guerlais M, Gerardin M, Lefebvre E, Duval M, Laforgue EJ, Victorri-Vigneau C. "Naloxone? Not for me!" First cross-assessment by patients and healthcare professionals of the risk of opioid overdose. Harm Reduct J 2024; 21:20. [PMID: 38263159 PMCID: PMC10804588 DOI: 10.1186/s12954-024-00941-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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 01/17/2024] [Indexed: 01/25/2024] Open
Abstract
BACKGROUND Opioid-related mortality is a rising public health concern in France, where opioids were in 2021 implicated in 75% of overdose deaths. Opioid substitution treatment (OST) was implicated in almost half of deaths related to substance and drug abuse. Although naloxone could prevent 80% of these deaths, there are a number of barriers to the distribution of take-home naloxone (THN) among opioid users in France. This study is the first one which compares patients' self-assessment of the risk of future opioid overdose with the hetero-assessment provided by healthcare professionals in a population of individuals eligible for naloxone. METHODS This was a multicenter descriptive observational study carried out in pharmacies across the Pays de la Loire region (France) during April and May 2022. All adult patients who visited a participating pharmacy for a prescription of OST and provided oral informed consent were enrolled in the study. Retrospective data were collected through cross-sectional interviews conducted by the pharmacist with the patient, utilizing an ad hoc questionnaire. The patient's self-assessment of overdose risk was evaluated using a Likert scale from 0 to 10. The pharmacist relied on the presence or absence of overdose risk situations defined by the French Health Authority (HAS). The need to hold THN was assessed using a composite criterion. RESULTS A total of 34 patients were interviewed; near one third were aware of the existence of THN and a minority had THN in their possession. Out of the 34 participants, 29 assessed their own risk of future opioid overdose: 65.5% reported having zero risk, while 6.9% believed they had a high risk. Nevertheless, at least one risk situation of opioid overdose was identified according to HAS criteria in 73.5% of the participants (n = 25). Consequently, 55% of the participants underestimated their risk of experiencing a future opioid overdose. Yet, dispensing THN has been judged necessary for 88.2% of the participants. CONCLUSION This study underscored the imperative need to inform not only healthcare professionals but also the patients and users themselves on the availability of THN and the risk situations of opioid overdose.
Collapse
Affiliation(s)
- Aurélie Aquizerate
- Nantes Université, CHU Nantes, Centre d'Evaluation et d'Information sur la Pharmacodépendance-Addictovigilance (CEIP-A), Service de Pharmacologie Clinique, 44000, Nantes, France
| | - Morgane Rousselet
- Nantes Université, CHU Nantes, Centre d'Evaluation et d'Information sur la Pharmacodépendance-Addictovigilance (CEIP-A), Service de Pharmacologie Clinique, 44000, Nantes, France
- Nantes Université, Univ Tours, CHU Nantes, CHU Tours, INSERM, MethodS in Patients-Centered Outcomes and HEalth Research, SPHERE, 44000, Nantes, France
| | - Axel Cochard
- Nantes Université, CHU Nantes, Centre d'Evaluation et d'Information sur la Pharmacodépendance-Addictovigilance (CEIP-A), Service de Pharmacologie Clinique, 44000, Nantes, France
| | - Marylène Guerlais
- Nantes Université, CHU Nantes, Centre d'Evaluation et d'Information sur la Pharmacodépendance-Addictovigilance (CEIP-A), Service de Pharmacologie Clinique, 44000, Nantes, France
| | - Marie Gerardin
- Nantes Université, CHU Nantes, Centre d'Evaluation et d'Information sur la Pharmacodépendance-Addictovigilance (CEIP-A), Service de Pharmacologie Clinique, 44000, Nantes, France
| | - Emilie Lefebvre
- Nantes Université, CHU Nantes, Centre d'Evaluation et d'Information sur la Pharmacodépendance-Addictovigilance (CEIP-A), Service de Pharmacologie Clinique, 44000, Nantes, France
| | - Mélanie Duval
- Nantes Université, CHU Nantes, Centre d'Evaluation et d'Information sur la Pharmacodépendance-Addictovigilance (CEIP-A), Service de Pharmacologie Clinique, 44000, Nantes, France
| | - Edouard-Jules Laforgue
- Nantes Université, CHU Nantes, Centre d'Evaluation et d'Information sur la Pharmacodépendance-Addictovigilance (CEIP-A), Service de Pharmacologie Clinique, 44000, Nantes, France
- Nantes Université, Univ Tours, CHU Nantes, CHU Tours, INSERM, MethodS in Patients-Centered Outcomes and HEalth Research, SPHERE, 44000, Nantes, France
| | - Caroline Victorri-Vigneau
- Nantes Université, CHU Nantes, Centre d'Evaluation et d'Information sur la Pharmacodépendance-Addictovigilance (CEIP-A), Service de Pharmacologie Clinique, 44000, Nantes, France.
- Nantes Université, Univ Tours, CHU Nantes, CHU Tours, INSERM, MethodS in Patients-Centered Outcomes and HEalth Research, SPHERE, 44000, Nantes, France.
| |
Collapse
|
38
|
Chau LQ, Crawford JR. Neuroimaging features of accidental fentanyl overdose in a toddler. BMJ Case Rep 2024; 17:e258524. [PMID: 38191218 PMCID: PMC10806892 DOI: 10.1136/bcr-2023-258524] [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] [Indexed: 01/10/2024] Open
Abstract
The opioid epidemic has become a significant public health crisis worldwide. With the rise in popularity of fentanyl, opioid overdoses continue to rise at unprecedented rates. Unfortunately, young children have become collateral damage in the face of the opioid epidemic. Accidental exposures and ingestions are the leading cause of opioid overdose in this age group and can result in significant acute complications, long-term sequelae and even death. We present the case of a toddler with accidental fentanyl ingestion who experienced seizures and required intubation for respiratory distress. He was found to have notable diffusion restriction cerebellar changes on MRI and ultimately discharged with normal neurological function. Our case adds to the growing literature of the clinical presentation and neuroimaging features associated with opioid toxicity in young children.
Collapse
Affiliation(s)
- Lianne Q Chau
- School of Medicine, University of California San Diego, La Jolla, California, USA
| | - John Ross Crawford
- Pediatrics, University of California Irvine, Irvine, California, USA
- Pediatrics, Children's Hospital Orange County, Orange, California, USA
| |
Collapse
|
39
|
Rawy M, Abdalla G, Look K. Polysubstance mortality trends in White and Black Americans during the opioid epidemic, 1999-2018. BMC Public Health 2024; 24:112. [PMID: 38184563 PMCID: PMC10771660 DOI: 10.1186/s12889-023-17563-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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Accepted: 12/21/2023] [Indexed: 01/08/2024] Open
Abstract
BACKGROUND Psychoactive drug combinations are increasingly contributing to overdose deaths among White and Black Americans. To understand the evolving nature of overdose crisis, inform policies, and develop tailored and equitable interventions, this study provides a comprehensive assessment of polysubstance mortality trends by race and sex during the opioid epidemic. METHODS We used serial cross-sectional US mortality data for White and Black populations from 1999 through 2018 to calculate annual age-adjusted death rates (AADR) involving any opioid, opioid subtypes, benzodiazepines, cocaine, psychostimulants, or combinations of these drugs, stratified by race and sex. Trend changes in AADR were analyzed using joinpoint regression models and expressed as average annual percent change (AAPC) during each period of the three waves of the opioid epidemic: 1999-2010 (wave 1), 2010-2013 (wave 2), and 2013-2018 (wave 3). Prevalence measures assessed the percent co-involvement of an investigated drug in the overall death from another drug. RESULTS Polysubstance mortality has shifted from a modest rise in death rates due to benzodiazepine-opioid overdoses among White persons (wave 1) to a substantial increase in death rates due to illicit drug combinations impacting both White and Black populations (wave 3). Concurrent cocaine-opioid use had the highest polysubstance mortality rates in 2018 among Black (5.28 per 100,000) and White (3.53 per 100,000) persons. The steepest increase in death rates during wave 3 was observed across all psychoactive drugs when combined with synthetic opioids in both racial groups. Since 2013, Black persons have died faster from cocaine-opioid and psychostimulant-opioid overdoses. Between 2013 and 2018, opioids were highly prevalent in cocaine-related deaths, increasing by 33% in White persons compared to 135% in Blacks. By 2018, opioids contributed to approximately half of psychostimulant and 85% of benzodiazepine fatal overdoses in both groups. The magnitude and type of drug combinations with the highest death rates differed by race and sex, with Black men exhibiting the highest overdose burden beginning in 2013. CONCLUSIONS The current drug crisis should be considered in the context of polysubstance use. Effective measures and policies are needed to curb synthetic opioid-involved deaths and address disparate mortality rates in Black communities.
Collapse
Affiliation(s)
- Marwa Rawy
- University of Wisconsin-Madison, Madison, USA.
| | | | - Kevin Look
- University of Wisconsin-Madison, Madison, USA
| |
Collapse
|
40
|
Lundstrom EW, Dai Z, Groth CP, Hendricks B, Winstanley EL, Abate M, Smith GS. Comparing the effects of decreasing prescription opioid shipments and the release of an abuse deterrent OxyContin formulation on opioid overdose fatalities in WV: an interrupted time series study. Subst Abuse Treat Prev Policy 2024; 19:4. [PMID: 38178238 PMCID: PMC10768117 DOI: 10.1186/s13011-023-00587-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [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: 06/21/2023] [Accepted: 12/12/2023] [Indexed: 01/06/2024] Open
Abstract
INTRODUCTION The 2010 release of an abuse deterrent formulation (ADF) of OxyContin, a brand name prescription opioid, has been cited as a major driver for the reduction in prescription drug misuse and the associated increasing illicit opioid use and overdose rates. However, studies of this topic often do not account for changes in supplies of other prescription opioids that were widely prescribed before and after the ADF OxyContin release, including generic oxycodone formulations and hydrocodone. We therefore sought to compare the impact of the ADF OxyContin release to that of decreasing prescription opioid supplies in West Virginia (WV). METHODS Opioid tablet shipment and overdose data were extracted from The Washington Post ARCOS (2006-2014) and the WV Forensic Drug Database (2005-2020), respectively. Locally estimated scatterplot smoothing (LOESS) was used to estimate the point when shipments of prescription opioids to WV began decreasing, measured via dosage units and morphine milligram equivalents (MMEs). Interrupted time series analysis (ITSA) was used to compare the impact LOESS-identified prescription supply changes and the ADF OxyContin release had on prescription (oxycodone and hydrocodone) and illicit (heroin, fentanyl, and fentanyl analogues) opioid overdose deaths in WV. Model fit was compared using Akaike Information Criteria (AIC). RESULTS The majority of opioid tablets shipped to WV from 2006 to 2014 were generic oxycodone or hydrocodone, not OxyContin. After accounting for a 6-month lag from ITSA models using the LOESS-identified change in prescription opioid shipments measured via dosage units (2011 Q3) resulted in the lowest AIC for both prescription (AIC = -188.6) and illicit opioid-involved overdoses (AIC = -189.4), indicating this intervention start date resulted in the preferred model. The second lowest AIC was for models using the ADF OxyContin release as an intervention start date. DISCUSSION We found that illicit opioid overdoses in WV began increasing closer to when prescription opioid shipments to the state began decreasing, not when the ADF OxyContin release occurred. Similarly, the majority of opioid tablets shipped to the state for 2006-2014 were generic oxycodone or hydrocodone. This may indicate that diminishing prescription supplies had a larger impact on opioid overdose patterns than the ADF OxyContin release in WV.
Collapse
Affiliation(s)
- Eric W Lundstrom
- Department of Epidemiology and Biostatistics, School of Public Health, West Virginia University, 64 Medical Center Dr, P.O. Box 9190, Morgantown, WV, 26506, US.
| | - Zheng Dai
- Health Affairs Institute, Health Sciences Center, West Virginia University, 405 Capitol Street, Suite 514, Charleston, WV, 25301, US
| | - Caroline P Groth
- Department of Epidemiology and Biostatistics, School of Public Health, West Virginia University, 64 Medical Center Dr, P.O. Box 9190, Morgantown, WV, 26506, US
| | - Brian Hendricks
- Department of Epidemiology and Biostatistics, School of Public Health, West Virginia University, 64 Medical Center Dr, P.O. Box 9190, Morgantown, WV, 26506, US
| | - Erin L Winstanley
- Department of Behavioral Medicine & Psychiatry, School of Medicine, West Virginia University, 930 Chestnut Ridge Rd, Morgantown, WV, 26505, US
| | - Marie Abate
- School of Pharmacy, West Virginia University, 64 Medical Center Drive, P.O. Box 9500, Morgantown, WV, 26506-9500, US
| | - Gordon S Smith
- Department of Epidemiology and Biostatistics, School of Public Health, West Virginia University, 64 Medical Center Dr, P.O. Box 9190, Morgantown, WV, 26506, US
| |
Collapse
|
41
|
Strauss DG, Li Z, Chaturbedi A, Chakravartula S, Samieegohar M, Mann J, Nallani SC, Prentice K, Shah A, Burkhart K, Boston J, Fu YHA, Dahan A, Zineh I, Florian JA. Intranasal Naloxone Repeat Dosing Strategies and Fentanyl Overdose: A Simulation-Based Randomized Clinical Trial. JAMA Netw Open 2024; 7:e2351839. [PMID: 38261323 PMCID: PMC10807299 DOI: 10.1001/jamanetworkopen.2023.51839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 11/28/2023] [Indexed: 01/24/2024] Open
Abstract
Importance Questions have emerged as to whether standard intranasal naloxone dosing recommendations (ie, 1 dose with readministration every 2-3 minutes if needed) are adequate in the era of illicitly manufactured fentanyl and its derivatives (hereinafter, fentanyl). Objective To compare naloxone plasma concentrations between different intranasal naloxone repeat dosing strategies and to estimate their effect on fentanyl overdose. Design, Setting, and Participants This unblinded crossover randomized clinical trial was conducted with healthy participants in a clinical pharmacology unit (Spaulding Clinical Research, West Bend, Wisconsin) in March 2021. Inclusion criteria included age 18 to 55 years, nonsmoking status, and negative test results for the presence of alcohol or drugs of abuse. Data analysis was performed from October 2021 to May 2023. Intervention Naloxone administered as 1 dose (4 mg/0.1 mL) at 0, 2.5, 5, and 7.5 minutes (test), 2 doses at 0 and 2.5 minutes (test), and 1 dose at 0 and 2.5 minutes (reference). Main Outcomes and Measures The primary outcome was the first prespecified time with higher naloxone plasma concentration. The secondary outcome was estimated brain hypoxia time following simulated fentanyl overdoses using a physiologic pharmacokinetic-pharmacodynamic model. Naloxone concentrations were compared using paired tests at 3 prespecified times across the 3 groups, and simulation results were summarized using descriptive statistics. Results This study included 21 participants, and 18 (86%) completed the trial. The median participant age was 34 years (IQR, 27-50 years), and slightly more than half of participants were men (11 [52%]). Compared with 1 naloxone dose at 0 and 2.5 minutes, 1 dose at 0, 2.5, 5, and 7.5 minutes significantly increased naloxone plasma concentration at 10 minutes (7.95 vs 4.42 ng/mL; geometric mean ratio, 1.95 [1-sided 97.8% CI, 1.28-∞]), whereas 2 doses at 0 and 2.5 minutes significantly increased the plasma concentration at 4.5 minutes (2.24 vs 1.23 ng/mL; geometric mean ratio, 1.98 [1-sided 97.8% CI, 1.03-∞]). No drug-related serious adverse events were reported. The median brain hypoxia time after a simulated fentanyl 2.97-mg intravenous bolus was 4.5 minutes (IQR, 2.1-∞ minutes) with 1 naloxone dose at 0 and 2.5 minutes, 4.5 minutes (IQR, 2.1-∞ minutes) with 1 naloxone dose at 0, 2.5, 5, and 7.5 minutes, and 3.7 minutes (IQR, 1.5-∞ minutes) with 2 naloxone doses at 0 and 2.5 minutes. Conclusions and Relevance In this clinical trial with healthy participants, compared with 1 intranasal naloxone dose administered at 0 and 2.5 minutes, 1 dose at 0, 2.5, 5, and 7.5 minutes significantly increased naloxone plasma concentration at 10 minutes, whereas 2 doses at 0 and 2.5 minutes significantly increased naloxone plasma concentration at 4.5 minutes. Additional research is needed to determine optimal naloxone dosing in the community setting. Trial Registration ClinicalTrials.gov Identifier: NCT04764630.
Collapse
Affiliation(s)
- David G. Strauss
- Division of Applied Regulatory Science, Office of Clinical Pharmacology, Office of Translational Sciences, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland
| | - Zhihua Li
- Division of Applied Regulatory Science, Office of Clinical Pharmacology, Office of Translational Sciences, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland
| | - Anik Chaturbedi
- Division of Applied Regulatory Science, Office of Clinical Pharmacology, Office of Translational Sciences, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland
| | - Shilpa Chakravartula
- Division of Applied Regulatory Science, Office of Clinical Pharmacology, Office of Translational Sciences, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland
| | - Mohammadreza Samieegohar
- Division of Applied Regulatory Science, Office of Clinical Pharmacology, Office of Translational Sciences, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland
| | - John Mann
- Division of Applied Regulatory Science, Office of Clinical Pharmacology, Office of Translational Sciences, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland
| | - Srikanth C. Nallani
- Division of Neuropsychiatric Pharmacology, Office of Clinical Pharmacology, Office of Translational Sciences, Center for Drug Evaluation and Research, US Food and Drug Administration. Silver Spring, Maryland
| | - Kristin Prentice
- Division of Applied Regulatory Science, Office of Clinical Pharmacology, Office of Translational Sciences, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland
- Booz Allen Hamilton, McLean, Virginia
| | - Aanchal Shah
- Division of Applied Regulatory Science, Office of Clinical Pharmacology, Office of Translational Sciences, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland
- Booz Allen Hamilton, McLean, Virginia
| | - Keith Burkhart
- Division of Applied Regulatory Science, Office of Clinical Pharmacology, Office of Translational Sciences, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland
| | | | | | - Albert Dahan
- Department of Anesthesiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Issam Zineh
- Office of Clinical Pharmacology, Office of Translational Sciences, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland
| | - Jeffry A. Florian
- Division of Applied Regulatory Science, Office of Clinical Pharmacology, Office of Translational Sciences, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland
| |
Collapse
|
42
|
Isenberg R. Opioid overdose after extended-release buprenorphine injection: a case report. Am J Drug Alcohol Abuse 2024; 50:123-124. [PMID: 38252881 DOI: 10.1080/00952990.2023.2292011] [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] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 12/03/2023] [Indexed: 01/24/2024]
Affiliation(s)
- Raluca Isenberg
- Division of Addiction Medicine, Cooper University Healthcare, Camden, NJ, USA
| |
Collapse
|
43
|
Ober AJ, Dopp AR, Clingan SE, Curtis ME, Lin C, Calhoun S, Larkins S, Black M, Hanano M, Osterhage KP, Baldwin LM, Saxon AJ, Hichborn EG, Marsch LA, Mooney LJ, Hser YI. Stakeholder perspectives on a telemedicine referral and coordination model to expand medication treatment for opioid use disorder in rural primary care clinics. J Subst Use Addict Treat 2024; 156:209194. [PMID: 37863356 DOI: 10.1016/j.josat.2023.209194] [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] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 04/11/2023] [Accepted: 10/16/2023] [Indexed: 10/22/2023]
Abstract
INTRODUCTION Opioid overdose deaths are increasing rapidly in the United States. Medications for opioid use disorder (MOUD) are effective and can be delivered in primary care, but uptake has been limited in rural communities. Referral to and coordination with an external telemedicine (TM) vendor by rural primary care clinics for MOUD (TM-MOUD) may increase MOUD access for rural patients, but we know little about perspectives on this model among key stakeholders. As part of a TM-MOUD feasibility study, we explored TM-MOUD acceptability and feasibility among personnel and patients from seven rural primary care clinics and a TM-MOUD vendor. METHODS We conducted virtual interviews or focus groups with clinic administrators (n = 7 interviews), clinic primary care and behavioral health providers (8 groups, n = 30), other clinic staff (9 groups, n = 37), patients receiving MOUD (n = 16 interviews), TM-MOUD vendor staff (n = 4 interviews), and vendor-affiliated behavioral health and prescribing providers (n = 17 interviews). We asked about experiences with and acceptability of MOUD (primarily buprenorphine) and telemedicine (TM) and a TM-MOUD referral and coordination model. We conducted content analysis to identify themes and participants quantitatively rated acceptability of TM-MOUD elements on a 4-item scale. RESULTS Perceived benefits of vendor-based TM-MOUD included reduced logistical barriers, more privacy and less stigma, and access to services not available locally (e.g., counseling, pain management). Barriers included lack of internet or poor connectivity in patients' homes, limited communication and trust between TM-MOUD and clinic providers, and questions about the value to the clinic of TM-MOUD referral to external vendor. Acceptability ratings for TM-MOUD were generally high; they were lowest among frontline staff. CONCLUSIONS Rural primary care clinic personnel, TM-MOUD vendor personnel, and patients generally perceived referral from primary care to a TM-MOUD vendor to hold potential for increasing access to MOUD in rural communities. Increasing TM-MOUD uptake requires buy-in and understanding among staff of the TM-MOUD workflow, TM services offered, requirements for patients, advantages over clinic-based or TM services from clinic providers, and identification of appropriate patients. Poverty, along with patient hesitation to initiate treatment, creates substantial barriers to MOUD treatment generally; insufficient internet availability creates a substantial barrier to TM-MOUD.
Collapse
Affiliation(s)
| | | | - Sarah E Clingan
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
| | - Megan E Curtis
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
| | - Chunqing Lin
- Semel Institute for Neuroscience and Human Behavior, Center for Community Health, University of California at Los Angeles, CA, USA
| | - Stacy Calhoun
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
| | - Sherry Larkins
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
| | - Megan Black
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
| | - Maria Hanano
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
| | - Katie P Osterhage
- Department of Family Medicine, University of Washington, Seattle, WA, USA
| | - Laura-Mae Baldwin
- Department of Family Medicine, University of Washington, Seattle, WA, USA
| | - Andrew J Saxon
- Veterans Affairs Puget Sound Health Care System, USA; Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA
| | - Emily G Hichborn
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, USA
| | - Lisa A Marsch
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, USA
| | - Larissa J Mooney
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
| | - Yih-Ing Hser
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
| |
Collapse
|
44
|
Bailey NR, Mitchell KA, Miller TM. Opioid Misuse Harm Reduction. J Addict Nurs 2024; 35:3-14. [PMID: 38373177 DOI: 10.1097/jan.0000000000000561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2024]
Abstract
BACKGROUND/AIMS The misuse of opioids by the public is a major health issue. Prescription opioids and nonprescription opioids, such as heroin and opium, are misused in epidemic proportions. When opioids are used incorrectly or illegally, they can lead to drug dependence, addiction, morbidity, and mortality. This program is in collaboration with the Jolt Foundation that provides resources to prevent opioid overdose deaths. DESIGN/METHODS This program involves community education on the dangers of opioid use and training on the use of naloxone rescue procedures to prevent overdose deaths. A pretest-posttest design was employed to determine if participants gained knowledge regarding the naloxone administration procedures. PARTICIPANTS The researcher presented 10 community naloxone trainings that included staff from 20 different social service agencies, two schools, and three local churches. Each agency received at least one naloxone kit. FINDINGS The outcomes were met and included educating 137 participants on the risk factors and signs and symptoms of opioid overdose and the proper procedure to administer naloxone. One hundred twenty-eight posttests were returned and showed that the objectives for the project were met. The overall mean score for the pretests was 65.00 ( n = 126) with a standard deviation of 19.01, and the overall mean for the posttests was 86.64 ( n = 128) with a standard deviation of 14.60. CONCLUSIONS Community social service agency staff were successfully educated to respond appropriately to overdose situations in a group training setting as evidenced by significant posttest scores.
Collapse
Affiliation(s)
- Nancy R Bailey
- Nancy R. Bailey, RN, DNP, Kimberly A. Mitchell, RN, PhD, CNE, and Theresa M. Miller, RN, PhD, Saint Francis Medical Center College of Nursing, Peoria, Illinois
| | | | | |
Collapse
|
45
|
Hossain S, Jackson A, Burkom H, Boyd C. Effects of the First Year of the COVID-19 Pandemic on Utilization of Emergency Medical Services in Maryland. J Public Health Manag Pract 2024; 30:E5-E13. [PMID: 37966957 DOI: 10.1097/phh.0000000000001843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2023]
Abstract
BACKGROUND The opioid epidemic in the United States has devastated the lives of individuals and imposed decades-long opportunity costs on the community. METHODS We analyzed Emergency Medical Services (EMS) data from the Maryland Department of Health installation of the Electronic Surveillance System for Early Notification of Community-Based Epidemics (ESSENCE) to assess the impact of COVID-19 on EMS call volume and how COVID-19 impacted patients' decisions whether to accept transport to a hospital following an EMS call. RESULTS The rate of patients accepting transportation via EMS to a hospital emergency department (ED) declined for both opioid-related and non-opioid-related calls from prepandemic (before April 2020) to mid-pandemic (mid-March 2020 to mid-April 2020). The opioid-related call volume increased more from pre- to mid-pandemic for male patients than for female patients, and this "gender gap" had not returned to prepandemic levels by April 2021. CONCLUSION Consistent with reports from other states, the pandemic worsened the opioid crisis in Maryland, impacting some populations more than others while also decreasing the likelihood that individuals experiencing an opioid-related overdose would seek further medical care following an EMS call.
Collapse
Affiliation(s)
- Sharmin Hossain
- Maryland Department of Human Services, Baltimore, Maryland (Dr Hossain); Johns Hopkins Applied Physics Laboratory, Laurel, Maryland (Ms Jackson and Mr Burkom); and Independent Researcher (Ms Boyd)
| | | | | | | |
Collapse
|
46
|
Heimer R, Black AC, Lin H, Grau LE, Fiellin DA, Howell BA, Hawk K, D'Onofrio G, Becker WC. Receipt of opioid use disorder treatments prior to fatal overdoses and comparison to no treatment in Connecticut, 2016-17. Drug Alcohol Depend 2024; 254:111040. [PMID: 38043226 PMCID: PMC10872282 DOI: 10.1016/j.drugalcdep.2023.111040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 11/12/2023] [Accepted: 11/18/2023] [Indexed: 12/05/2023]
Abstract
OBJECTIVE To determine the relative risk of death following exposure to treatments for OUD compared to no treatment. METHODS In this retrospective cohort study we compiled and merged state agency data on accidental and undetermined opioid overdose deaths in 2017 and exposures to OUD treatment in the prior six months to determine incidence rates following exposure to different treatment modalities. These rates were compared to the estimated incidence among those exposed to no treatment to determine relative risk of death for each treatment exposure. RESULTS Incidence rates for opioid poisoning deaths for those exposed to treatment ranged from 6.06±1.40 per 1000 persons exposed to methadone to 17.36±3.22 per 1000 persons exposed to any non-medication treatment. The estimated incidence rate for those not exposed to treatment was 9.80±0.72 per 1000 persons. With no exposure to treatment as referent, exposure to methadone or buprenorphine reduced the relative risk by 38% or 34%, respectively; the relative risk of non-medication treatments was equal to or worse than no exposure to treatment (RR = 1.27-1.77). PRINCIPAL CONCLUSIONS Exposure to non-MOUD treatments provided no protection against fatal opioid poisoning whereas the relative risk was reduced following exposures to MOUD treatment, even if treatment was not continued. Population level efforts to reduce opioid overdose deaths need to focus on expanding access to agonist-based MOUD treatments and are unlikely to succeed if access to non-MOUD treatments is made more available.
Collapse
Affiliation(s)
- Robert Heimer
- Yale School of Public Health, New Haven, CT, United States.
| | - Anne C Black
- Yale School of Medicine, New Haven, CT, United States; VA Connecticut Healthcare System, West Haven, CT, United States
| | - Hsiuju Lin
- University of Connecticut School of Social Work, Hartford, CT, United States
| | | | - David A Fiellin
- Yale School of Public Health, New Haven, CT, United States; Yale School of Medicine, New Haven, CT, United States
| | | | - Kathryn Hawk
- Yale School of Public Health, New Haven, CT, United States; Yale School of Medicine, New Haven, CT, United States
| | - Gail D'Onofrio
- Yale School of Public Health, New Haven, CT, United States; Yale School of Medicine, New Haven, CT, United States
| | - William C Becker
- Yale School of Medicine, New Haven, CT, United States; VA Connecticut Healthcare System, West Haven, CT, United States
| |
Collapse
|
47
|
Hoang AT, Corradin O. Epigenetic alterations identify a confluence of genetic vulnerabilities tied to opioid overdose. Neuropsychopharmacology 2024; 49:333-334. [PMID: 37587380 PMCID: PMC10700520 DOI: 10.1038/s41386-023-01701-5] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Affiliation(s)
- An T Hoang
- Whitehead Institute for Biomedical Research, Cambridge, MA, USA
| | - Olivia Corradin
- Whitehead Institute for Biomedical Research, Cambridge, MA, USA.
- Massachusetts Institute of Technology, Department of Biology, Cambridge, MA, USA.
| |
Collapse
|
48
|
Tin Y, Castry M, Bowers-Sword R, Shantharam S, Aldridge A, Zarkin GA, Starbird L, Linas BP, Barocas JA, Morgan JR. Establishing a Protocol for Determining the Costs of an Integrated Set of Evidence-based Practices Aimed at Reducing Opioid Overdose Deaths. J Addict Med 2024; 18:13-18. [PMID: 37768777 PMCID: PMC10872250 DOI: 10.1097/adm.0000000000001218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/30/2023]
Abstract
OBJECTIVES In the midst of the opioid overdose crisis, local jurisdictions face a choice of public health interventions. A significant barrier when considering evidence-based practices (EBPs) is the lack of information regarding their implementation cost. This protocol paper provides the methodological foundation for the economic cost evaluations of community-wide strategies on the scale of a national study. It can serve as a resource for other communities, local policymakers, and stakeholders as they consider implementing possible public health strategies in their unique settings. METHODS We present a protocol that details (1) the process of identifying, reviewing, and analyzing individual strategies for study-funded and non-study-funded costs; (2) prospective costing tool designation, and; (3) data collection. To do this, we set up working groups with community stakeholders, reviewed financial invoices, and surveyed individuals with detailed knowledge of their community implementation. DISCUSSION There were 3 main challenges/limitations. The first was the lack of a standard structure for documenting nonfunded costs associated with each strategy. The second was the need for timely implementation of cost data. The third was generalizability because our study designed its strategies for selected communities due to their high opioid overdose mortality rates. Future steps include more tailored questions to ask during the categorization/filter process and establishing realistic expectations for organizations regarding documenting. CONCLUSIONS Data collected will provide a critical methodological foundation for costing large community-based EBP strategies and provide clarity for stakeholders on the cost of implementing EBP strategies to reduce opioid overdose deaths.
Collapse
Affiliation(s)
- Yjuliana Tin
- Section of Infectious Diseases, Boston Medical Center (BMC), Boston, MA
| | - Mathieu Castry
- Section of Infectious Diseases, Boston Medical Center (BMC), Boston, MA
| | | | | | - Arnie Aldridge
- RTI International, Research Triangle Park, North Carolina
| | - Gary A. Zarkin
- RTI International, Research Triangle Park, North Carolina
| | - Laura Starbird
- University of Pennsylvania School of Nursing, Philadelphia, PA
| | - Benjamin P. Linas
- Section of Infectious Diseases, Boston Medical Center (BMC), Boston, MA
- Boston University School of Medicine, Boston, MA
| | - Joshua A. Barocas
- Divisions of General Internal Medicine and Infectious Diseases, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Jake R. Morgan
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, MA
| |
Collapse
|
49
|
Brown AM, White DG, Adams NB, PharmD RR, Shaikh S, Guluma L. Validation of the Enhanced Opioid Identification and Co-occurring Disorders Algorithms. Vital Health Stat 1 2024:1-31. [PMID: 38285805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/31/2024]
Abstract
Objectives This report documents the results of a validation study conducted to assess the reliability of two algorithms applied to the 2016 National Hospital Care Survey. One algorithm identifies opioid-involved and opioid overdose hospital encounters, and the other identifies encounters with patients that have substance use disorders and selected mental health issues. These algorithms use both medical codes and natural language processing to identify encounters. Methods To validate the algorithms, medical record abstraction was performed on a stratified sample of 900 hospital encounters from the 2016 National Hospital Care Survey. The abstractors recorded their determinations of opioid involvement, opioid overdose, substance use disorder, and mental health issues on a standard form. Abstractors' determinations were compared with algorithm output to assess the overall performance using F-score and Matthews correlation coefficient. The latter provided a secondary measure of performance. The 2016 National Hospital Care Survey data are unweighted and not nationally representative. Results Overall algorithm performance varied by topic and by metric. The opioid-involvement algorithm achieved the highest performance, performing well with an F-score of 0.95, followed by the substance use disorder algorithm (F-score of 0.79), the mental health issues algorithm (F-score of 0.68), and the opioid overdose algorithm (F-score of 0.48). Assessment by Matthews correlation coefficient indicated an overall poorer level of performance, ranging from a high of 0.57 for the mental health issues algorithm to a low of 0.33 for the opioid-involvement algorithm. The causes of false positives and false negatives likewise varied, including both overly broad code and keyword inclusions as well as incompleteness of data submitted to the National Hospital Care Survey. Conclusion The validation study illustrates which aspects of the developed algorithms performed well and which aspects should be altered or discarded in future iterations. It further emphasizes the importance of data completeness, therefore laying the groundwork for improvements to future survey analyses.
Collapse
|
50
|
Hughes PM, Ostrach B, Tak CR. Examining differences in opioid deaths by race in North Carolina following the STOP Act, 2010-2019. J Subst Use Addict Treat 2023; 155:209171. [PMID: 37739125 DOI: 10.1016/j.josat.2023.209171] [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] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 07/11/2023] [Accepted: 09/19/2023] [Indexed: 09/24/2023]
Abstract
INTRODUCTION North Carolina's 2017 STOP Act implemented several measures to address the increasing opioid overdose death rate. However, due to racial differences prescription opioid use and treatment service access, the STOP Act may exhibit differential impacts by race. This study examined the impact of the STOP Act on opioid overdose deaths by race. METHODS State-level secondary data were compiled for all 50 states. Race-stratified opioid overdose rates were obtained from the Centers for Disease Control and Prevention's WONDER database from 2010 to 2019. The study obtained state-level population characteristics from the Current Population Surveys from 2010 to 2016, the CDC's 2017 Drug Surveillance Report, the National Survey of Substance Abuse Treatment Services from 2011 to 2016, and the National Survey on Drug Use and Health from 2010 to 2016. We obtained outcomes from 2010 to 2019 and state characteristics were obtained for the pre-STOP Act period (2010-2016) as available. Using the synthetic control method, we created two synthetic North Carolinas, one Black/African American and one White, from a weighted average of other states similar to North Carolina in terms of pre-STOP Act race-stratified opioid overdose rates and population characteristics. Change was assessed as the difference in the race-stratified opioid overdose death rate for North Carolina the corresponding synthetic control. RESULTS The opioid overdose death rate among the White population decreased by 7.17 and 8.96 deaths/100 k in 2018 and 2019 following the STOP Act (overall decrease p = .0217); however, the study found no significant change in the opioid overdose death rate among the Black/African American population (overall decrease p = .1053), with decreases 1.68 and 3.2 deaths/100 k in 2018 and 2019, respectively. CONCLUSIONS Our findings suggest that the STOP Act reduced the opioid overdose death rate in North Carolina among the White, but not Black/African American, population. This heterogeneous effect has implications for health equity and can inform the development of future substance use policies.
Collapse
Affiliation(s)
- Phillip M Hughes
- Division of Pharmaceutical Outcomes and Policy, University of North Carolina Eshelman School of Pharmacy, Chapel Hill, NC, United States of America; Division of Research, UNC Health Sciences at MAHEC, Asheville, NC, United States of America.
| | - Bayla Ostrach
- Medical Anthropology & Family Medicine, Boston University School of Medicine, Boston, MA, United States of America
| | - Casey R Tak
- Department of Pharmacotherapy, University of Utah College of Pharmacy, Salt Lake City, UT, United States of America
| |
Collapse
|