Journal articles on the topic 'Drug overdose prevention'
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Hargrove, Sarah L., Terry L. Bunn, Svetla Slavova, Dana Quesinberry, Tracey Corey, William Ralston, Michael D. Singleton, and Van Ingram. "Establishment of a comprehensive drug overdose fatality surveillance system in Kentucky to inform drug overdose prevention policies, interventions and best practices." Injury Prevention 24, no. 1 (July 24, 2017): 60–67. http://dx.doi.org/10.1136/injuryprev-2016-042308.
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BackgroundAccording to the National Center for Health Statistics, Kentucky had the third highest drug overdose fatality rate in the nation in 2015 at 29.9 drug overdose fatalities per 100 000 population.ObjectiveThe elevated drug overdose fatality rate necessitated the development and implementation of a comprehensive multisource drug overdose fatality surveillance system (DOFSS).MethodsDOFSS stakeholder work group members and data sources were identified, and memorandums of understanding were established. The following data sources were used to establish DOFSS: (1) death certificates; (2) autopsy reports; (3) toxicology result reports; (4) coroner reports; and (5) Kentucky All Schedule Prescription Electronic Reporting (KASPER) (prescription drug monitoring programme) data. Drug overdose poisonings were defined using Injury Surveillance Workgroup 7 definitions. Analyses were performed to investigate possible drug overdose-related health disparities for disabled drug overdose decedents and to characterise gabapentin in drug overdose deaths.ResultsDOFSS identified 2106 drug overdose poisoning fatalities in Kentucky for 2013–2014. Identification of specific drugs involved in drug overdose deaths increased from 75.8% using a single data source to 97.5% using multiple data sources. Disabled drug overdose decedents were significantly more likely to have an active prescription for drugs identified in their system compared with the non-disabled drug overdose decedents. Toxicology data showed increased gabapentin involvement in drug overdose deaths from 2.9% in 2013 to 17% in 2014. Alprazolam was found most often in combination with gabapentin (41%), along with various other benzodiazepines and prescription opioids.ConclusionsA comprehensive multisource DOFSS improved drug overdose fatality surveillance by increasing completeness of data and data quality. DOFSS is a model that can be considered by other states to enhance their efforts in tracking drug overdose fatalities, identifying new and emerging trends, and informing policies and best practices, to address and reduce drug overdoses.
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Lombardi, Alexa Rose, Ritikraj Arya, Joseph G. Rosen, Erin Thompson, Ralph Welwean, Jessica Tardif, Josiah D. Rich, and Ju Nyeong Park. "Overdose Detection Technologies to Reduce Solitary Overdose Deaths: A Literature Review." International Journal of Environmental Research and Public Health 20, no. 2 (January 10, 2023): 1230. http://dx.doi.org/10.3390/ijerph20021230.
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Drug overdoses were a leading cause of injury and death in the United States in 2021. Solitary drug use and solitary overdose deaths have remained persistent challenges warranting additional attention throughout the overdose epidemic. The goal of this narrative review is to describe recent global innovations in overdose detection technologies (ODT) enabling rapid responses to overdose events, especially for people who use drugs alone. We found that only a small number of technologies designed to assist in overdose detection and response are currently commercially available, though several are in the early stages of development. Research, development, and scale-up of practical, cost-effective ODTs remains a public health imperative. Equipping places where people live, learn, work, worship, and play with the necessary tools to detect and prevent overdose deaths could complement ongoing overdose prevention efforts.
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Walters, Suzan M., Marisa Felsher, David Frank, Jessica Jaiswal, Tarlise Townsend, Brandon Muncan, Alex S. Bennett, et al. "I Don’t Believe a Person Has to Die When Trying to Get High: Overdose Prevention and Response Strategies in Rural Illinois." International Journal of Environmental Research and Public Health 20, no. 2 (January 16, 2023): 1648. http://dx.doi.org/10.3390/ijerph20021648.
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Background: Overdose is a leading cause of morbidity and mortality among people who inject drugs. Illicitly manufactured fentanyl is now a major driver of opioid overdose deaths. Methods: Semi-structured interviews were conducted with 23 participants (19 persons who inject drugs and 4 service providers) from rural southern Illinois. Data were analyzed using constant comparison and theoretical sampling methods. Results: Participants were concerned about the growing presence of fentanyl in both opioids and stimulants, and many disclosed overdose experiences. Strategies participants reported using to lower overdose risk included purchasing drugs from trusted sellers and modifying drug use practices by partially injecting and/or changing the route of transmission. Approximately half of persons who inject drugs sampled had heard of fentanyl test strips, however fentanyl test strip use was low. To reverse overdoses, participants reported using cold water baths. Use of naloxone to reverse overdose was low. Barriers to naloxone access and use included fear of arrest and opioid withdrawal. Conclusions: People who inject drugs understood fentanyl to be a potential contaminant in their drug supply and actively engaged in harm reduction techniques to try to prevent overdose. Interventions to increase harm reduction education and information about and access to fentanyl test strips and naloxone would be beneficial.
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Vivolo-Kantor, Alana, Emilia Pasalic, Stephen Liu, Pedro D. Martinez, and Robert Matthew Gladden. "Defining indicators for drug overdose emergency department visits and hospitalisations in ICD-10-CM coded discharge data." Injury Prevention 27, Suppl 1 (March 2021): i56—i61. http://dx.doi.org/10.1136/injuryprev-2019-043521.
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IntroductionThe drug overdose epidemic has worsened over the past decade; however, efforts have been made to better understand and track nonfatal overdoses using various data sources including emergency department and hospital admission data from billing and discharge files.Methods and findingsThe Centers for Disease Control and Prevention (CDC) has developed surveillance case definition guidance using standardised discharge diagnosis codes for public health practitioners and epidemiologists using lessons learnt from CDC’s funded recipients and the Council for State and Territorial Epidemiologists (CSTE) International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) Drug Poisoning Indicators Workgroup and General Injury ICD-10-CM Workgroup. CDC’s guidance was informed by health departments and CSTE’s workgroups and included several key aspects for assessing drug overdose in emergency department and hospitalisation discharge data. These include: (1) searching all diagnosis fields to identify drug overdose cases; (2) estimating drug overdose incidence using visits for initial encounter but excluding subsequent encounters and sequelae; (3) excluding underdosing and adverse effects from drug overdose incidence indicators; and (4) using codes T36–T50 for overdose surveillance. CDC’s guidance also suggests analysing intent separately for ICD-10-CM coding.ConclusionsCDC’s guidance provides health departments a key tool to better monitor drug overdoses in their community. The implementation and validation of this standardised guidance across all CDC-funded health departments will be key to ensuring consistent and accurate reporting across all entities.
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Beswick, Tracy, David Best, Jenny Bearn, Sian Rees, Michael Gossop, Ross Coomber, and John Strang. "From Salt Injection to Naloxone: Accuracy and Myths in Peer Resuscitation Methods for Opiate Overdose." Journal of Drug Issues 32, no. 4 (October 2002): 1103–14. http://dx.doi.org/10.1177/002204260203200406.
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One hundred and eight opiate addicts attending an in-patient opiate treatment unit were interviewed, using a mixed quantitative–qualitative approach, to investigate their experiences of witnessing overdoses, the associated interpretations and perceived cause of the overdose. Poly drug use and frequency of witnessed overdose was high among the sample. Use of 14 different combinations of drugs were reported, 8 of which involved the use of alcohol, and 7 benzodiazepines. Perceived cause of overdose involved attributions relating to the use of alcohol, in particular strong lager, small quantities of heroin and low levels of current opiate tolerance. Peer initiated resuscitation techniques revealed a range of responses from the probably valuable (recovery position, summon ambulance, administer naloxone) to the ineffective or frankly harmful (injecting with salt solution, immersing in a cold bath). The findings highlight the need for an overdose prevention program during in-patient detoxification and rehabilitation.
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Banta-Green, Caleb J., Phillip O. Coffin, Joseph O. Merrill, Jeanne M. Sears, Chris Dunn, Anthony S. Floyd, Lauren K. Whiteside, Norbert D. Yanez, and Dennis M. Donovan. "Impacts of an opioid overdose prevention intervention delivered subsequent to acute care." Injury Prevention 25, no. 3 (February 7, 2018): 191–98. http://dx.doi.org/10.1136/injuryprev-2017-042676.
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BackgroundOpioid overdose is a major and increasing cause of injury and death. There is an urgent need for interventions to reduce overdose events among high-risk persons.MethodsAdults at elevated risk for opioid overdose involving heroin or pharmaceutical opioids who had been cared for in an emergency department (ED) were randomised to overdose education combined with a brief behavioural intervention and take-home naloxone or usual care. Outcomes included: (1) time to first opioid overdose-related event resulting in medical attention or death using competing risks survival analysis; and (2) ED visit and hospitalisation rates, using negative binomial regression and adjusting for time at risk.ResultsDuring the follow-up period, 24% of the 241 participants had at least one overdose event, 85% had one or more ED visits and 55% had at least one hospitalisation, with no significant differences between intervention and comparison groups. The instantaneous risk of an overdose event was not significantly lower for the intervention group (sub-HR: 0.83; 95% CI 0.49 to 1.40).DiscussionThese null findings may be due in part to the severity of the population in terms of housing insecurity (70% impermanently housed), drug use, unemployment and acute healthcare issues. Given the high overdose and healthcare utilisation rates, more intensive interventions, such as direct referral and provision of housing and opioid agonist treatment medications, may be necessary to have a substantial impact on opioid overdoses for this high-acuity population in acute care settings.Trial registration numberNCT0178830; Results.
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Buxton, Jane A., Bill Spearn, Ashraf Amlani, Margot Kuo, Mark Lysyshyn, Sara Young, Roy Purssell, et al. "The British Columbia Drug Overdose and Alert Partnership: Interpreting and sharing timely illicit drug information to reduce harms." Journal of Community Safety and Well-Being 4, no. 1 (April 30, 2019): 4. http://dx.doi.org/10.35502/jcswb.92.
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Illicit drug overdose is a public health issue that leads to significant morbidity and mortality. In order to reduce the harm associated with substance use, emergent issues related to substances and substance use must be addressed in a timely manner, which requires inter-sectoral collaboration. We describe the British Columbia Drug Overdose and Alert Partnership, an innovative collaborative model of stakeholders who work in prevention, harm reduction, treatment and enforcement related to psychoactive substance use. We describe the formation, purpose, stakeholders, and operation of the partnership and resultant public health surveillance system. We use the example of fentanyl-associated overdoses and deaths to describe the attributes that make the system effective. These include timeliness, flexibility, acceptability and costs. This model of inter-sectoral collaboration and surveillance can be applied to other organizations involved in assessing and responding to drug-related harms.
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Crowell, et al, Tara. "Examining Opioid Overdose Data in Atlantic County: A Descriptive Case Study." New Jersey Studies: An Interdisciplinary Journal 5, no. 2 (July 16, 2019): 125. http://dx.doi.org/10.14713/njs.v5i2.170.
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Between 2015-2017, local police, state troopers and emergency medical personnel in Atlantic County, NJ collected data on opioid overdose victims within the County. Forms on 311 overdose victims were ultimately completed. Early in 2018, a partnership between the Atlantic County Prosecutor’s Office and Stockton University was formed in order to analyze this information and better understand Atlantic County’s opioid overdose statistics. Results painted a picture of who is using, and showed that quick response to opioid overdoses and prompt administration of the drug naloxone can save lives. Recommendations for the future include collecting additional data points for overdose victims going forward to allow for deeper study, along with increased distribution of naloxone. Such recommendations can positively contribute to future educational and prevention efforts.
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Lankenau, Stephen E., Karla D. Wagner, Karol Silva, Aleksandar Kecojevic, Ellen Iverson, Miles McNeely, and Alex H. Kral. "Injection Drug Users Trained by Overdose Prevention Programs: Responses to Witnessed Overdoses." Journal of Community Health 38, no. 1 (July 31, 2012): 133–41. http://dx.doi.org/10.1007/s10900-012-9591-7.
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Bohnert, Amy S. B., Melissa Tracy, and Sandro Galea. "Characteristics of drug users who witness many overdoses: Implications for overdose prevention." Drug and Alcohol Dependence 120, no. 1-3 (January 2012): 168–73. http://dx.doi.org/10.1016/j.drugalcdep.2011.07.018.
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Wiens, Terra, Elisabeth Bilden, Stefan Saravia, Jason Peterson, Matthew Wogen, Kaila Hanson, Roon Makhtal, Nate Wright, Jon Roesler, and Ruth Lynfield. "Biosurveillance of Drug Overdoses and Substance Misuse Treated in Selected Emergency Departments in Minnesota, 2017-2020." Public Health Reports 136, no. 1_suppl (November 2021): 87S—95S. http://dx.doi.org/10.1177/00333549211042834.
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Objectives Increasing knowledge about the toxicology of drug overdose and substance misuse (DOSM) is important in improving our understanding of the epidemic. We describe the Minnesota Drug Overdose and Substance Use Pilot Surveillance Activity, which started collecting data on emergency department (ED) visits attributable to DOSM in 2017, with a focus on the toxicology results of a subset of clinical encounters. Methods From November 1, 2017, through January 30, 2020, we collected near–real-time data on DOSM-related ED encounters. The Minnesota Department of Health Public Health Laboratory tested leftover clinical specimens (blood and/or urine) for the presence of various substances for patients who died, were hospitalized, had an atypical clinical presentation, or were part of a local drug overdose cluster. Testing looked for >250 drugs or their metabolites, including those commonly misused (eg, methamphetamine, cocaine), prescription medications, synthetic cannabinoids and cathinones, and opioids. We describe characteristics of the overall group and a subgroup of clinical encounters with toxicology results. Results Specimens submitted from 6 EDs during the study period represented 239 clinical encounters. Methamphetamine was the most frequently detected substance (67.4%) but was suspected in only 45.6% of encounters. At least 1 opioid was detected in 42.5% of encounters but suspected in only 29.7%. Testing also detected potential adulterants and additives (eg, fentanyl, fentanyl analogues, levamisole) and showed frequent patient exposure to substances not reported by patients or suspected by clinicians. Nearly half (44.4%) of clinical encounters had >1 substance detected. Conclusions ED surveillance for DOSM encounters, enhanced by toxicology testing, can provide local situational awareness on overdoses, prevent potential mischaracterization of the true drug overdose epidemic, and inform harm reduction and drug overdose prevention efforts.
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Siegel, Shepard. "The Heroin Overdose Mystery." Current Directions in Psychological Science 25, no. 6 (December 2016): 375–79. http://dx.doi.org/10.1177/0963721416664404.
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Heroin overdose deaths in the Unites States more than tripled from 2010 to 2014, reaching almost 11,000 per year. Despite the use of the term “overdose,” many of these victims died after self-administering an amount of opiate that would not be expected to be fatal for these drug-experienced, and drug-tolerant, individuals. Various explanations of this overdose mystery have been proposed. I describe an explanation based on Pavlovian conditioning. Organisms associate cues present at the time of drug administration with the systemic effect of the drug. These drug-predictive cues come to elicit responses that attenuate the effect of a drug. Such anticipatory conditional responses mediate chronic tolerance. If the drug is administered in the presence of novel cues, tolerance fails to occur and the victim suffers an overdose. Overdose prevention strategies should incorporate information about the contribution of drug-associated cues to drug tolerance.
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Minton, Neil A., and John A. Hentry. "Prevention of Drug Absorption in Simulated Theophylline Overdose." Journal of Toxicology: Clinical Toxicology 33, no. 1 (January 1995): 43–49. http://dx.doi.org/10.3109/15563659509020214.
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Joob, Beuy, and Viroj Wiwanitkit. "Attempting suicide by drug overdose and its prevention." Dusunen Adam: The Journal of Psychiatry and Neurological Sciences 31, no. 1 (March 30, 2018): 113–14. http://dx.doi.org/10.5350/dajpn2018310114.
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Minton, Neil A., Edward Glucksman, and John A. Henry. "Prevention of drug absorption in simulated theophylline overdose." Human & Experimental Toxicology 14, no. 2 (February 1995): 170–74. http://dx.doi.org/10.1177/096032719501400203.
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1 The effects of emesis, gastric lavage and oral activated charcoal on theophylline absorption were compared in healthy volunteers. 2 One of four regimes (ipecacuanha-induced emesis, gas tric lavage, oral activated charcoal and no treatment) was randomly chosen one hour after a simulated over dose with sustained-release theophylline on four sepa rate occasions in twelve healthy volunteers. 3 Syrup of ipecacuanha produced emesis in all twelve volunteers but only seven vomited any tablets. Gastric lavage yielded tablets in only one volunteer. 4 The mean systemic availabilities (areas under the con centration-time curves relative to control) of theo phylline for ipecacuanha-induced emesis, gastric lavage and charcoal, were 107.1%, 101.1% and 16.9%, respectively. 5 Oral activated charcoal was thus highly effective, while gastric lavage and emesis were ineffective in pre venting theophylline absorption. Activated charcoal is potentially the most effective first-line treatment for acute overdosage with sustained-release theophylline tablets.
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Khoshnood, Kaveh, Fatma Sheb, Danielle Khouri, Elie Aaraj, Russell Barbour, Forrest Crawford, Jacques Mokhbat, Alyssa Parpia, and Robert Heimer. "Reported history and correlates of drug overdose among people who inject drugs in Lebanon." Eastern Mediterranean Health Journal 27, no. 6 (June 30, 2021): 571–79. http://dx.doi.org/10.26719/2021.27.6.571.
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Background: Opioid overdose is an issue of increasing concern, and better epidemiologic data are needed to implement effective treatment programmes. Few published reports address the frequency of fatal or non-fatal opioid overdose in countries in the Middle East and North Africa region. Aims: We provide the first-ever study of the reported history and correlates of drug overdose among a broad sample of out-of-treatment people who inject drugs (PWID) in Lebanon. Methods: This was a respondent-driven sampling, cross-sectional, biobehavioural study carried out in Beirut, Lebanon, between October 2014 and February 2015. Data were collected on sociodemographics, risk profiles, drug use histories, drug and sexual risk behaviours, history of substance use treatment and incarceration, and pertinent infectious disease test results. Results: We recruited 382 eligible PWID. The majority were Lebanese (95.3%) men (95.5%), with an average age of 30.3 (standard deviation 9.9) years. A history of drug overdose was reported in 171 (44.8%) PWID. Around 86% reported heroin as the first drug they had ever injected. Approximately half (53.0%) reported a history of substance use treatment, and 80.1% reported a history of arrest for the injection or possession of drugs. Our analysis demonstrates that, after adjusting for relevant covariates, drug overdose is associated with a history of incarceration, drug treatment, and an increased number of arrests in one’s lifetime for drug injection or possession. Conclusions: The observed associations suggest overdose prevention programmes may be effective if targeted to recently incarcerated people and to those receiving drug treatment.
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Davis, Corey, Damika Webb, and Scott Burris. "Changing Law from Barrier to Facilitator of Opioid Overdose Prevention." Journal of Law, Medicine & Ethics 41, S1 (2013): 33–36. http://dx.doi.org/10.1111/jlme.12035.
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Drug overdose has recently surpassed motor vehicle accidents to become the leading cause of unintentional injury death in the United States. The epidemic is largely driven by opioids such as oxycodone, hydrocodone, and methadone, which kill more Americans than heroin and cocaine combined. The demographics of overdose have changed over the past few decades as well: according to the latest data, the average overdose victim is now a non-Hispanic white man aged 45-54.These deaths — over 16,000 per year — are almost entirely preventable. Opioid overdose kills by slowly depressing respiration, a process that can take several hours. It can be quickly and effectively reversed by the timely administration of naloxone, an opioid antagonist that works by displacing opioids from the brain receptors to which they attach, reversing their depressant effect. Naloxone, also known as Narcan, has many benefits and minimal risks. Although it is a prescription drug, it is not a controlled substance and has no abuse potential.
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Otterstatter, Michael C., Alexis Crabtree, Sabina Dobrer, Brooke Kinniburgh, Salman Klar, Anthony Leamon, Jennifer May-Hadford, et al. "Patterns of health care utilization among people who overdosed from illegal drugs: a descriptive analysis using the BC Provincial Overdose Cohort." Health Promotion and Chronic Disease Prevention in Canada 38, no. 9 (September 2018): 328–38. http://dx.doi.org/10.24095/hpcdp.38.9.04.
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Introduction British Columbia (BC) declared a public health emergency in April 2016 in response to a rapid rise in overdose deaths. Further understanding of health care utilization is needed to inform prevention strategies for individuals who overdose from illegal drugs. Methods The Provincial Overdose Cohort includes linked administrative data on health care utilization by individuals who experienced an illegal drug overdose event in BC between 1 January 2015 and 30 November 2016. Overdose cases were identified using data from ambulance services, coroners’ investigations, poison control centre calls and hospital, emergency department and physician administrative records. In total, 10 455 overdose cases were identified and compared with 52 275 controls matched on age, sex and area of residence for a descriptive analysis of health care utilization. Results Two-thirds (66%) of overdose cases were male and about half (49%) were 20–39 years old. Over half of the cases (54%) visited the emergency department and about one-quarter (26%) were admitted to hospital in the year before the overdose event, compared with 17% and 9% of controls, respectively. Nevertheless, nearly onefifth (19%) of cases were recorded leaving the emergency department without being seen or against medical advice. High proportions of both cases (75%) and controls (72%) visited community-based physicians. Substance use and mental health–related concerns were the most common diagnoses among people who went on to overdose. Conclusion People who overdosed frequently accessed the health care system in the year before the overdose event. In light of the high rates of health care use, there may be opportunities to identify at-risk individuals before they overdose and connect them with targeted programs and evidence-based interventions. Further work using the BC Provincial Overdose Cohort will focus on identifying risk factors for overdose events and death by overdose.
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Bolinski, Rebecca S., Suzan Walters, Elizabeth Salisbury-Afshar, Lawrence J. Ouellet, Wiley D. Jenkins, Ellen Almirol, Brent Van Ham, et al. "The Impact of the COVID-19 Pandemic on Drug Use Behaviors, Fentanyl Exposure, and Harm Reduction Service Support among People Who Use Drugs in Rural Settings." International Journal of Environmental Research and Public Health 19, no. 4 (February 16, 2022): 2230. http://dx.doi.org/10.3390/ijerph19042230.
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Background: The COVID-19 pandemic has worsened the opioid overdose crisis in the US. Rural communities have been disproportionately affected by opioid use and people who use drugs in these settings may be acutely vulnerable to pandemic-related disruptions due to high rates of poverty, social isolation, and pervasive resource limitations. Methods: We performed a mixed-methods study to assess the impact of the pandemic in a convenience sample of people who use drugs in rural Illinois. We conducted 50 surveys capturing demographics, drug availability, drug use, sharing practices, and mental health symptoms. In total, 19 qualitative interviews were performed to further explore COVID-19 knowledge, impact on personal and community life, drug acquisition and use, overdose, and protective substance use adaptations. Results: Drug use increased during the pandemic, including the use of fentanyl products such as gel encapsulated “beans” and “buttons”. Disruptions in supply, including the decreased availability of heroin, increased methamphetamine costs and a concomitant rise in local methamphetamine production, and possible fentanyl contamination of methamphetamine was reported. Participants reported increased drug use alone, experience and/or witness of overdose, depression, anxiety, and loneliness. Consistent access to harm reduction services, including naloxone and fentanyl test strips, was highlighted as a source of hope and community resiliency. Conclusions: The COVID-19 pandemic period was characterized by changing drug availability, increased overdose risk, and other drug-related harms faced by people who use drugs in rural areas. Our findings emphasize the importance of ensuring access to harm reduction services, including overdose prevention and drug checking for this vulnerable population.
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Friedman, Joseph, and Samir Akre. "COVID-19 and the Drug Overdose Crisis: Uncovering the Deadliest Months in the United States, January‒July 2020." American Journal of Public Health 111, no. 7 (July 2021): 1284–91. http://dx.doi.org/10.2105/ajph.2021.306256.
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Objectives. To determine the magnitude of increases in monthly drug-related overdose mortality during the COVID-19 pandemic in the United States. Methods. We leveraged provisional records from the Centers for Disease Control and Prevention provided as rolling 12-month sums, which are helpful for smoothing, yet may mask pandemic-related spikes in overdose mortality. We cross-referenced these rolling aggregates with previous monthly data to estimate monthly drug-related overdose mortality for January through July 2020. We quantified historical errors stemming from reporting delays and estimated empirically derived 95% prediction intervals (PIs). Results. We found that 9192 (95% PI = 8988, 9397) people died from drug overdose in May 2020—making it the deadliest month on record—representing a 57.7% (95% PI = 54.2%, 61.2%) increase over May 2019. Most states saw large-magnitude increases, with the highest in West Virginia, Kentucky, and Tennessee. We observed low concordance between rolling 12-month aggregates and monthly pandemic-related shocks. Conclusions. Unprecedented increases in overdose mortality occurred during the pandemic, highlighting the value of presenting monthly values alongside smoothed aggregates for detecting shocks. Public Health Implications. Drastic exacerbations of the US overdose crisis warrant renewed investments in overdose surveillance and prevention during the pandemic response and postpandemic recovery efforts.
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Lee, Eun-Hae, Ju-Ok Park, Joon-Pil Cho, and Choung-Ah Lee. "Prioritising Risk Factors for Prescription Drug Overdose among Older Adults in South Korea: A Multi-Method Study." International Journal of Environmental Research and Public Health 18, no. 11 (June 1, 2021): 5948. http://dx.doi.org/10.3390/ijerph18115948.
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Older adults are vulnerable to drug overdose. We used a multi-method approach to prioritise risk factors for prescription drug overdose among older adults. The study was conducted in two stages. First, risk factors for drug overdose were classified according to importance and changeability through literature review, determined through 2-phase expert surveys. Second, prescription drug overdose cases during 2011–2015 were selected from a national cohort; the prevalence of ‘more important’ or ‘more changeable’ factors determined in stage one was investigated. Scores were assigned according to the Basic Priority Rating Scale formula, reflecting the problem size and seriousness and intervention effectiveness. In the first stage, polypharmacy, old-old age, female sex, chronic disease, psychiatric disease, and low socioeconomic status (SES) were selected as risk factors. In the second stage, 93.9% of cases enrolled had chronic medical disease; 78.3% were using multiple drugs. Low SES was more prevalent than other risk factors. As per the scoring formula, chronic medical disease, polypharmacy, psychiatric disease, low SES, female sex, and old-old age were the most important risk factors in order of priority. Patients with chronic medical disease and those using multiple medications should be prioritised in overdose prevention interventions among older adults.
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Boyd, Jade, Lisa Maher, Tamar Austin, Jennifer Lavalley, Thomas Kerr, and Ryan McNeil. "Mothers Who Use Drugs: Closing the Gaps in Harm Reduction Response Amidst the Dual Epidemics of Overdose and Violence in a Canadian Urban Setting." American Journal of Public Health 112, S2 (April 2022): S191—S198. http://dx.doi.org/10.2105/ajph.2022.306776.
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Objectives. To identify key gaps in overdose prevention interventions for mothers who use drugs and the paradoxical impact of institutional practices that can increase overdose risk in the context of punitive drug policies and a toxic drug supply. Methods. Semistructured interviews were conducted with 40 women accessing 2 women-only, low-barrier supervised consumption sites in Greater Vancouver, British Columbia, Canada, between 2017 and 2019. Our analysis drew on intersectional understandings of structural, everyday, and symbolic violence. Results. Participants’ substance use and overdose risk (e.g., injecting alone) was shaped by fear of institutional and partner scrutiny and loss (or feared loss) of child custody or reunification. Findings indicate that punitive policies and institutional practices that frame women who use drugs as unfit parents continue to negatively shape the lives of women, most significantly among Indigenous participants. Conclusions. Nonpunitive policies, including access to safe, nontoxic drug supplies, are critical first steps to decreasing women’s overdose risk alongside gender-specific and culturally informed harm-reduction responses, including community-based, peer-led initiatives to maintain parent–child relationships. (Am J Public Health. 2022;112(S2):S191–S198. https://doi.org/10.2105/AJPH.2022.306776 )
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Pap, Ágota, and Katalin Hegedűs. "The message of the heroin overdoses." Orvosi Hetilap 156, no. 9 (March 2015): 352–57. http://dx.doi.org/10.1556/oh.2015.30091.
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Drug use can be defined as a kind of self destruction, and it is directly linked to attitudes toward death and suicide occurring in a significant number of users of different narcotics. The aim of the authors was to look for the background of this relationship between drug and death and examine the origin, development, and motives behind heroin overdose based on an analysis of previous studies. It seems clear that pure heroin overdose increased gradually over the years. The fear of the police is the inhibitory factor of the overdose prevention and notification of emergency health care service. Signs of suicide could be the own home as the chosen location for heroin overdose and the presence of partners (“moment of death companion”). Interventions should include simple techniques such as first aid, naloxone administration, resuscitation, prevention of relapse of prisoners and social network extension involving maintenance programs. Orv. Hetil., 2015, 156(9), 352–357.
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Byers, Amy, Yixia Li, Shira Maguen, and Thomas Neylan. "PTSD, Risk of Suicide, and Unintended Death by Overdose in Late Life." Innovation in Aging 4, Supplement_1 (December 1, 2020): 747. http://dx.doi.org/10.1093/geroni/igaa057.2688.
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Abstract Little is known about late-life posttraumatic stress disorder (PTSD) and risk of suicide and apparent accidental death by overdose. We studied 488,044 older veterans (50 and older) with PTSD and propensity-matched comparison group without PTSD (n=488,044), seen in VA 2012-2013 followed to 12/31/2016. There were 5,693 non-fatal and fatal suicide attempts for those with PTSD and 4,310 for those without PTSD (approximately 20% fatal for each group). Those with PTSD had nearly 2-fold increased risk of any attempt [HR=1.55 (95% CI=1.49-1.62)]. While results specific to death by suicide were non-significant, impact of PTSD on method of death (e.g., drug overdose, firearms, hanging) was significant only for drug overdose [HR=1.58 (95% CI=1.22-2.03)]. Intentional and unintentional death by narcotics and such drugs as non-opioid analgesics and autonomic nervous system drugs were most highly associated with late-life PTSD. This study provides important implications for late-life suicide prevention related to PTSD and cause-specific drugs. Part of a symposium sponsored by the Aging, Alcohol and Addictions Interest Group.
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Febres-Cordero, Sarah, and Daniel Jackson Smith. "Stayin’ Alive in Little 5: Application of Sentiment Analysis to Investigate Emotions of Service Industry Workers Responding to Drug Overdoses." International Journal of Environmental Research and Public Health 19, no. 20 (October 12, 2022): 13103. http://dx.doi.org/10.3390/ijerph192013103.
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The opioid epidemic has increasingly been recognized as a public health issue and has challenged our current legal, social, and ethical beliefs regarding drug use. The epidemic not only impacts persons who use drugs, but also those around them, including people who do not expect to witness an overdose. For example, in the commercial district of Little 5 Points, Atlanta, GA, many service industry workers have become de facto responders to opioid overdoses when a person experiences an opioid-involved overdose in their place of employment. To provide additional insights into >300 pages of interview data collected from service industry workers that have responded to an opioid overdose while at work, we utilized a mixed-methods approach to conduct this sentiment analysis. First, using R version 4.2.1, a data-science based textual analytic approach was applied to the interview data. Using a corpus algorithm, each line of interview text was characterized as one of the eight following sentiments, anger, anticipation, disgust, fear, joy, sadness, surprise, or trust. Once having identified statements that fit into each of these eight codes, qualitative thematic analysis was conducted. The three most prevalent emotions elucidated from these interviews with service industry workers were trust, anticipation, and joy with 20.4%, 16.2%, and 14.7% across all statements, respectively labeled as each emotion. Thematic analysis revealed three themes in the data: (1) individuals have a part to address in the opioid epidemic, (2) communities have many needs related to the opioid crisis, and (3) structural forces create pathways and barriers to opioid overdose response and rescue. This analysis thematically identified roles service industry workers have in addressing the opioid crisis in Atlanta. Similarly, community needs and barriers to responding to an opioid-involved overdose were characterized. Uniquely, this study found key sentiments related to each of these themes. Future research can leverage these findings to inform the development of overdose prevention and response interventions for service industry works that systematically address common emotions and beliefs trainees may have.
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Drake, Jasmine, Creaque Charles, Jennifer W. Bourgeois, Elycia S. Daniel, and Melissa Kwende. "Exploring the impact of the opioid epidemic in Black and Hispanic communities in the United States." Drug Science, Policy and Law 6 (January 2020): 205032452094042. http://dx.doi.org/10.1177/2050324520940428.
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Context: In recent years, due to an alarming increase in the number of opioid-related overdose fatalities for White, Non-Hispanics in rural and suburban communities across the United States, they have been considered as the face of this epidemic. However, there has also been a staggering rise in the number of opioid overdoses in urban, minority communities, which have not been thoroughly addressed by the literature. Methods We reviewed deaths where opioid-related substances were reported as the leading cause of death to the Centers of Disease Control Multiple Cause of Death database from 1999 to 2017. Deaths were analyzed by year, State, drug type, and race and ethnicity. Results There were 399,230 total opioid-related deaths from 1999 to 2017 amongst all ethnic groups in the U.S. During this timeframe, approximately 323,939 total deaths were attributed to White, Non-Hispanics, while 75,291 were attributed to all other ethnicities. Examination of opioid-related overdose death data by ethnicity reveals that while White, Non-Hispanics have experienced the largest numbers of opioid-related overdose deaths in the U.S with up to 37,113 deaths occurring during 2017, there has also been a sharp rise in the number of opioid-related overdose deaths for minorities. opioid-related overdose deaths for Black, Non-Hispanics climbed from 1130 deaths in 1999 to 5513 deaths in 2017, while opioid-related overdose deaths for Hispanics climbed from 1058 in 1999 to 3932 in 2017. According to the Centers for Disease Control and Prevention, over the past 19 years, age-adjusted opioid-related deaths for Hispanics have climbed from 3.5 overdoses per 100,000 in 1999 to 6.8 overdoses per 100,000 in 2017. However, greater increases have been reported for Blacks during the same 19-year timeframe with age-adjusted rates of 3.5 overdoses per population of 100,000 in 1999 to 12.9 overdoses per population of 100,000 in 2017. Conclusion While Opioid-related overdoses have overwhelmingly plagued rural and suburban White, Non-Hispanic communities, there has been a surge in the number of deaths in Black and Hispanic Minority communities in recent years. Although there have been significant increases in the number of opioid-related overdose deaths in Black and Hispanic communities, the media narrative for this epidemic is often portrayed as a White, Non-Hispanic rural and suburban crisis. As a result, intervention strategies and policies have failed, both, to assess the severity of the problem in minority communities and to offer culturally sensitive preventative and treatment solutions. In this paper, the impact of the opioid epidemic on Black and Hispanic minority communities will be presented. Racial disparities in the U.S. Government’s current approach to an epidemic, which plagues rural and suburban White America, will be compared to its past criminal justice response to drug pandemics in urban minority communities. Culturally sensitive policy considerations and recommendations that can be used to, both, mitigate and offer treatment options for the opioid epidemic in these minority communities will also be addressed.
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Kurdil, N. V. "The drug poisoning (overdose): age aspect of the problem." Ukrainian Journal of Modern Toxicological Aspects 92, no. 1 (November 11, 2022): 84–96. http://dx.doi.org/10.33273/2663-4570-2022-92-1-84-96.
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Abstract. Relevance. In recent decades, age groups among drug users have changed in many countries around the world. A person's age significantly influences the choice of drug, which in turn determines the state of his physical and mental health and life expectancy. Aim. To study the age structure of drug poisoning (overdose) among the adult population of a large city (Kyiv) to determine measures to improve the effectiveness of medical care and prevention of socially significant poisoning among the working population. Materials and Methods. Medical data of patients diagnosed with "Acute drug poisoning" (ICD-10:T40.0-T40.3) were studied. Chemical-analytical studies were performed using immunochromatographic analysis, gas and liquid chromatography and mass spectrometry. Statistical data processing was performed using analysis of variance (ANOVA) with Fisher's test at p≤0,05. Results. In the period 1990–2020, the Kyiv Toxicology Center provided medical care to about 60,000 patients with acute poisoning, among whom the age groups predominated: 30–39 years and 40–49 years. During this period, about 28,000 patients with drug poisoning (overdose) were treated, most of whom were patients aged 20–39 years. It was found that among people with opioid poisoning the age group of 20–29 years decreased (p = 0,0285) and the age group of 30–39 years increased (p = 0,0343). In other age groups: 15–19 years (p = 0,9211), 40–49 years (p = 0,8047), 50–59 years (p = 0,5879), over 60 years (p = 0,09) statistically significant changes were not observed. Among the stimulants of psychostimulants were dominated by age groups: 15–19 years, 20–29 years and 30–39 years, but statistically significant changes in the age structure of patients were not observed. There were also no statistically significant changes in the age groups of patients with combined poisoning. In 1990–2020, a decrease in hospital mortality was found among patients with drug poisoning (overdose) in the age group 15–19 years (p = 0,0144), in other groups no statistically significant changes were found. Deaths from overdoses are mostly males aged 20–49 (95,1 %). Conclusions. According to the results of research, it is established that among patients with drug poisoning (overdose) predominate young people – 20–39 years. There is a gradual decrease in the age group of 20–29 years and an increase in the age group of 30–39 years, which may be due to the "maturation" of this cohort of drug users. No statistically significant increase in the age of drug users was found, this cohort remains young in contrast to the United States and the EU, where a cohort of consumers (mostly opioids) aged 50 and older is gradually increasing. Key Words: drugs, poisoning, age.
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Atluri, Sairam. "Prevention of Opioid Abuse in Chronic NonCancer Pain: An Algorithmic, Evidence Based Approach." July 2012 3S;15, no. 3S;7 (July 14, 2012): ES177—ES189. http://dx.doi.org/10.36076/ppj.2012/15/es177.
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Background: The use of opioids for chronic non-cancer pain has grown exponentially in the last 15 years. Associated with that, dramatic increases in abuse and overdose deaths from opioid use have been noted. Objectives: Most opioid abuse stems from legitimate prescriptions, putting the onus on prescribers to use opioids responsibly for chronic pain. Very little evidence-based guidance exists for those who wish to prescribe opioids for legitimate chronic pain and at the same time prevent opioid abuse. Methods: A review of literature was performed for articles focused on guidelines for opioid use when prescribed for chronic pain, opioid abuse, and overdose, strategies to detect and prevent abuse of opioids, urine drug screens (UDS) in chronic pain settings, prescription monitoring programs (PMP), and the relationship between opioid dosing and abuse. Results: Based on the existing literature, an evidence-based algorithmic approach was developed to decrease opioid abuse in the chronic pain environment. The pillars of prevention are the screening of patients into high, medium, and low risk categories using screening tools; monitoring patients using UDS, PMP, and pill counts, and lastly, dose limitations. Conclusion: This algorithmic approach may enable physicians to prescribe opioids for patients with chronic pain and also to reduce opioid abuse. Key words: Opioids, chronic pain, abuse, prescription, overdose, deaths, overdose deaths, urine drug screens, prescription monitoring programs, opioid dose, screening, monitoring
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McKelvie, Sylvia. "“Smack in the Middle”: Urban Governance and the Spatialization of Overdose Epidemics." City & Community 19, no. 3 (September 2020): 704–25. http://dx.doi.org/10.1111/cico.12456.
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In recent years, cities in North America have declared public health emergencies in response to opioid–related overdoses and fatalities. Municipalities are reacting with various interventions and degrees of urgency, whereas harm reduction organizations coordinate the street–level fight against death. Though drug use has long been concentrated in urbanized and downtown areas, these neighborhoods are being addressed with new national attention. This article draws on qualitative interviews with participants in the Downtown Eastside (DTES) in Vancouver and the Tenderloin in San Francisco. I highlight two interconnected themes: (1) the legacy of distrust between municipal officials and drug users and (2) the disconnection between “epidemics” as narrowly constructed public health emergencies and the needs of communities. Findings show ongoing struggles with “progressive” urban agendas. San Francisco minimized fatalities thanks to the early introduction of unregulated naloxone; however, new anti–homelessness legislation and police–led initiatives continue to create social upheaval for drug users. In comparison, the rollout of Vancouver's naloxone program arrived 10 years too late. Organizations are attempting to amplify access to safe injection and overdose prevention sites in the DTES. Using interurban analysis, overdose epidemics can be conceptualized as sociospatial fields of power, providing greater insight into urban marginality and health inequalities.
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Eigner, Gregory, Brian Henriksen, Philip Huynh, David Murphy, Christopher Brubaker, Jana Sanders, and Deborah McMahan. "Who is Overdosing? An Updated Picture of Overdose Deaths From 2008 to 2015." Health Services Research and Managerial Epidemiology 4 (January 1, 2017): 233339281772742. http://dx.doi.org/10.1177/2333392817727424.
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Purpose: To determine the role of opioids in drug overdose deaths in Allen County, Indiana between January 1, 2008, and December 31, 2015. Methods: File review of 418 overdose deaths was performed using Indiana State Department of Health death certificates available through the Allen County Coroner’s Office. Data from autopsy and toxicology reports and coroner-requested prescribing data from Indiana’s Prescription Monitoring Program were reviewed. Cause of death and available data were analyzed to identify patterns and trends related to overdose deaths. Results: Four hundred eighteen drug overdose deaths were identified (336 accidental, 66 intentional, and 16 undetermined). Mean age was 42.5 years, 88.5% were Caucasian, and 68.7% were employed. The majority of deaths occurred at a place of residence (71.4%) and with other people present (57.5% of the time). Depression was the most common comorbidity identified. The most common drug classes identified by toxicology were opioids, followed by benzodiazepines. Significant increases in both heroin (35% of deaths in 2015 versus 8.2% in 2013) and fentanyl (30% of deaths in 2015 versus 2.2% in 2011) were observed. Conclusions: Drug overdose continues to be a significant cause of death in Allen County. The majority of deaths were accidental and in relatively young, employed individuals. Prevention and awareness strategies should be encouraged, given that the majority of overdose deaths occurred at a place of residence with other people frequently present. Additional concerns about patterns of drug use were confirmed with marked increases in both heroin and fentanyl contributing to overdose deaths in the latter part of the study.
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Cepeda, Javier A., Marina V. Vetrova, Alexandra I. Lyubimova, Olga S. Levina, Robert Heimer, and Linda M. Niccolai. "Community reentry challenges after release from prison among people who inject drugs in St. Petersburg, Russia." International Journal of Prisoner Health 11, no. 3 (September 21, 2015): 183–92. http://dx.doi.org/10.1108/ijph-03-2015-0007.
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Purpose – Little is known about the context of the post-release risk environment among formerly incarcerated people who inject drugs (PWID) in Russia. The purpose of this paper is to explore these challenges as they relate to reentry, relapse to injection opioid use, and overdose. Design/methodology/approach – The authors conducted 25 in-depth semi-structured interviews among PWID living in St Petersburg, Russia who had been incarcerated within the past two years. Participants were recruited from street outreach (n=20) and a drug treatment center (n=5). Findings – Emergent themes related to the post-release environment included financial instability, negative interactions with police, return to a drug using community, and reuniting with drug using peers. Many respondents relapsed to opioid use immediately after release. Those whose relapse occurred weeks or months after their release expressed more motivation to resist. Alcohol or stimulant use often preceded the opioid relapse episode. Among those who overdosed, alcohol use was often reported prior to overdosing on opioids. Practical implications – Future post-release interventions in Russia should effectively link PWID to social, medical, and harm reduction services. Particular attention should be focussed on helping former inmates find employment and overdose prevention training prior to leaving prison that should also cover the heightened risk of concomitant alcohol use. Originality/value – In addition to describing a syndemic involving the intersection of incarceration, injection drug use, poverty, and alcohol abuse, the findings can inform future interventions to address these interrelated public health challenges within the Russian setting.
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Ripperger, Michael, Sarah C. Lotspeich, Drew Wilimitis, Carrie E. Fry, Allison Roberts, Matthew Lenert, Charlotte Cherry, et al. "Ensemble learning to predict opioid-related overdose using statewide prescription drug monitoring program and hospital discharge data in the state of Tennessee." Journal of the American Medical Informatics Association 29, no. 1 (October 19, 2021): 22–32. http://dx.doi.org/10.1093/jamia/ocab218.
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Abstract Objective To develop and validate algorithms for predicting 30-day fatal and nonfatal opioid-related overdose using statewide data sources including prescription drug monitoring program data, Hospital Discharge Data System data, and Tennessee (TN) vital records. Current overdose prevention efforts in TN rely on descriptive and retrospective analyses without prognostication. Materials and Methods Study data included 3 041 668 TN patients with 71 479 191 controlled substance prescriptions from 2012 to 2017. Statewide data and socioeconomic indicators were used to train, ensemble, and calibrate 10 nonparametric “weak learner” models. Validation was performed using area under the receiver operating curve (AUROC), area under the precision recall curve, risk concentration, and Spiegelhalter z-test statistic. Results Within 30 days, 2574 fatal overdoses occurred after 4912 prescriptions (0.0069%) and 8455 nonfatal overdoses occurred after 19 460 prescriptions (0.027%). Discrimination and calibration improved after ensembling (AUROC: 0.79–0.83; Spiegelhalter P value: 0–.12). Risk concentration captured 47–52% of cases in the top quantiles of predicted probabilities. Discussion Partitioning and ensembling enabled all study data to be used given computational limits and helped mediate case imbalance. Predicting risk at the prescription level can aggregate risk to the patient, provider, pharmacy, county, and regional levels. Implementing these models into Tennessee Department of Health systems might enable more granular risk quantification. Prospective validation with more recent data is needed. Conclusion Predicting opioid-related overdose risk at statewide scales remains difficult and models like these, which required a partnership between an academic institution and state health agency to develop, may complement traditional epidemiological methods of risk identification and inform public health decisions.
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Reinert, Justin, Rachel Leis, Alison Paplaskas, and Deborah Bakle-Carn. "Defining the Correlation Between Heroin Overdose and Length of Hospital Admissions." Journal of Pharmacy Technology 35, no. 6 (June 28, 2019): 243–50. http://dx.doi.org/10.1177/8755122519860081.
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Background:: Heroin has had an overwhelming impact on public welfare and health resources. National surveillance data indicate a 25% increase in drug overdose deaths in Ohio between 2012 and 2017, ranking the state second in terms of drug overdose deaths associated with opioids. Objective:: The primary objective of this evaluation was to determine the length of hospital stay in suspected or confirmed heroin overdose. Methods:: This retrospective analysis evaluated adult patients presenting to the emergency department (ED) at Mercy Health St Vincent Medical Center with confirmed or suspected heroin overdose. Patient data were obtained from the International Classification of Diseases, 10th revision, code reports. The study site is a 462-bed academic medical center with a level 1 trauma designation located in downtown Toledo, OH. Results:: One-hundred and one patients were included in this study: 49 presented to the ED and were subsequently admitted, while 52 were evaluated in the ED and discharged. No statistically significant differences in demographic data were identified. The average length of stay for admitted patients was 4.39 days (range = 0-22 days) with an average of 1.91days in the intensive care unit and 2.48 days on a general medicine floor. Higher average amounts of naloxone administered prior to presentation to the ED were found to predict an admission to the intensive care unit (6.48 mg vs 2.43 mg, P = .0208). The most frequent necessary interventions were central line placement (16/49, 32.7%) and mechanical ventilation (15/49, 30.6%). Seven patients (14.3%) experienced a cardiac arrest. Conclusion:: Heroin overdoses continue to require emergent interventions and consume numerous health care resources. Investment in strategies for prevention of overdose and the subsequent utilization of resources is paramount in controlling the heroin epidemic in Ohio and nationally.
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Eisenberg, Matthew D., Alexander McCourt, Elizabeth A. Stuart, Lainie Rutkow, Kayla N. Tormohlen, Michael I. Fingerhood, Luis Quintero, Sarah A. White, and Emma Elizabeth McGinty. "Studying how state health services delivery policies can mitigate the effects of disasters on drug addiction treatment and overdose: Protocol for a mixed-methods study." PLOS ONE 16, no. 12 (December 16, 2021): e0261115. http://dx.doi.org/10.1371/journal.pone.0261115.
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Background The United States is experiencing a drug addiction and overdose crisis, made worse by the COVID-19 pandemic. Relative to other types of health services, addiction treatment and overdose prevention services are particularly vulnerable to disaster-related disruptions for multiple reasons including fragmentation from the general medical system and stigma, which may lead decisionmakers and providers to de-prioritize these services during disasters. In response to the COVID-19 pandemic, U.S. states implemented multiple policies designed to mitigate disruptions to addiction treatment and overdose prevention services, for example policies expanding access to addiction treatment delivered via telehealth and policies designed to support continuity of naloxone distribution programs. There is limited evidence on the effects of these policies on addiction treatment and overdose. This evidence is needed to inform state policy design in future disasters, as well as to inform decisions regarding whether to sustain these policies post-pandemic. Methods The overall study uses a concurrent-embedded design. Aims 1–2 use difference-in-differences analyses of large-scale observational databases to examine how state policies designed to mitigate the effects of the COVID-19 pandemic on health services delivery influenced addiction treatment delivery and overdose during the pandemic. Aim 3 uses a qualitative embedded multiple case study approach, in which we characterize local implementation of the state policies of interest; most public health disaster policies are enacted at the state level but implemented at the local level by healthcare systems and local public health authorities. Discussion Triangulation of results across methods will yield robust understanding of whether and how state disaster-response policies influenced drug addiction treatment and overdose during the COVID-19 pandemic. Results will inform policy enactment and implementation in future public health disasters. Results will also inform decisions about whether to sustain COVID-19 pandemic-related changes to policies governing delivery addiction and overdose prevention services long-term.
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Jalal, Hawre, Jeanine M. Buchanich, Mark S. Roberts, Lauren C. Balmert, Kun Zhang, and Donald S. Burke. "Changing dynamics of the drug overdose epidemic in the United States from 1979 through 2016." Science 361, no. 6408 (September 20, 2018): eaau1184. http://dx.doi.org/10.1126/science.aau1184.
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Better understanding of the dynamics of the current U.S. overdose epidemic may aid in the development of more effective prevention and control strategies. We analyzed records of 599,255 deaths from 1979 through 2016 from the National Vital Statistics System in which accidental drug poisoning was identified as the main cause of death. By examining all available data on accidental poisoning deaths back to 1979 and showing that the overall 38-year curve is exponential, we provide evidence that the current wave of opioid overdose deaths (due to prescription opioids, heroin, and fentanyl) may just be the latest manifestation of a more fundamental longer-term process. The 38+ year smooth exponential curve of total U.S. annual accidental drug poisoning deaths is a composite of multiple distinctive subepidemics of different drugs (primarily prescription opioids, heroin, methadone, synthetic opioids, cocaine, and methamphetamine), each with its own specific demographic and geographic characteristics.
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Alexandridis, Apostolos A., Agnieszka McCort, Christopher L. Ringwalt, Nidhi Sachdeva, Catherine Sanford, Stephen W. Marshall, Karin Mack, and Nabarun Dasgupta. "A statewide evaluation of seven strategies to reduce opioid overdose in North Carolina." Injury Prevention 24, no. 1 (August 23, 2017): 48–54. http://dx.doi.org/10.1136/injuryprev-2017-042396.
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BackgroundIn response to increasing opioid overdoses, US prevention efforts have focused on prescriber education and supply, demand and harm reduction strategies. Limited evidence informs which interventions are effective. We evaluated Project Lazarus, a centralised statewide intervention designed to prevent opioid overdose.MethodsObservational intervention study of seven strategies. 74 of 100 North Carolina counties implemented the intervention. Dichotomous variables were constructed for each strategy by county-month. Exposure data were: process logs, surveys, addiction treatment interviews, prescription drug monitoring data. Outcomes were: unintentional and undetermined opioid overdose deaths, overdose-related emergency department (ED) visits. Interrupted time-series Poisson regression was used to estimate rates during preintervention (2009–2012) and intervention periods (2013–2014). Adjusted IRR controlled for prescriptions, county health status and time trends. Time-lagged regression models considered delayed impact (0–6 months).ResultsIn adjusted immediate-impact models, provider education was associated with lower overdose mortality (IRR 0.91; 95% CI 0.81 to 1.02) but little change in overdose-related ED visits. Policies to limit ED opioid dispensing were associated with lower mortality (IRR 0.97; 95% CI 0.87 to 1.07), but higher ED visits (IRR 1.06; 95% CI 1.01 to 1.12). Expansions of medication-assisted treatment (MAT) were associated with increased mortality (IRR 1.22; 95% CI 1.08 to 1.37) but lower ED visits in time-lagged models.ConclusionsProvider education related to pain management and addiction treatment, and ED policies limiting opioid dispensing showed modest immediate reductions in mortality. MAT expansions showed beneficial effects in reducing ED-related overdose visits in time-lagged models, despite an unexpected adverse association with mortality.
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Moallef, Soroush, Ekaterina Nosova, M. J. Milloy, Kora DeBeck, Nadia Fairbairn, Evan Wood, Thomas Kerr, and Kanna Hayashi. "Knowledge of Fentanyl and Perceived Risk of Overdose Among Persons Who Use Drugs in Vancouver, Canada." Public Health Reports 134, no. 4 (June 18, 2019): 423–31. http://dx.doi.org/10.1177/0033354919857084.
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Objectives: In North America, the illicit drug supply is increasingly contaminated by illicitly manufactured fentanyl. We sought to assess the level and source of fentanyl risk knowledge, defined as knowledge of the overdose risks associated with fentanyl, and characterize the prevalence and correlates of perceived risk of personally having a fentanyl overdose among persons who use illicit drugs (PWUD) in Vancouver, British Columbia. Methods: We derived data from 3 prospective cohorts of PWUD in Vancouver from December 2016 through May 2017. We used multivariable ordinal regression analysis to identify factors associated with a lower perceived risk of having a fentanyl overdose. Results: Of 1166 participants, 1095 (93.9%) had fentanyl risk knowledge. Of 1137 participants who answered questions about their perceived risk of having a fentanyl overdose, 398 (35.0%) perceived having no risk, 426 (37.5%) perceived having low risk, and 313 (27.5%) perceived having moderate or high risk. Never or rarely using opioids (n = 541, 65.7%) was the most common reason for reporting no or low perceived risk (n = 824), whereas 137 (16.6%) participants reported daily heroin use. In multivariable analysis, compared with participants who perceived a moderate or high risk, participants who perceived a lower risk were less likely to report a recent nonfatal overdose (adjusted odds ratio [aOR] = 0.28; P < .001), recent injection drug use (aOR = 0.34; P < .001), and awareness of recent exposure to fentanyl (aOR = 0.34; P < .001). Conclusion: Despite a high level of fentanyl risk knowledge, most study participants did not translate this knowledge into a risk of having an overdose. Although participants who perceived a lower risk were less likely to have had an overdose, a considerable proportion was engaged in daily opioid use, suggesting the need to improve overdose prevention efforts.
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Paul, Sindy M., and Virginia Allread. "The Misuse and Abuse of Prescription Medications: Medical Regulation, Prevention and Care Initiatives in New Jersey." Journal of Medical Regulation 100, no. 3 (September 1, 2014): 7–18. http://dx.doi.org/10.30770/2572-1852-100.3.7.
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ABSTRACT Prescription drug abuse is considered the fastest growing drug problem in the United States. The major increase is in unintentional drug overdose from opioid analgesics, which has caused more overdose-related deaths since 2003 than cocaine and heroin combined. The misuse of prescription pills is becoming particularly prevalent among suburban and rural youth in the United States, sometimes leading to heroin addiction and putting this population at a higher risk of blood-borne pathogens where heroin is injected. New Jersey has spearheaded initiatives to address misuse of opioid analgesics. These initiatives, which are part of an overall strategy and include medical regulatory response, are consistent with the newly (2013) updated Federation of State Medical Boards (FSMB) guidelines to better educate physicians and aid in the proper diagnosis and treatment of pain. They address physician prescribing practices, consumer need for safe disposal and treatment, and educational campaigns that target providers and the general public.
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Horigian, Viviana E., Renae D. Schmidt, Dikla Shmueli-Blumberg, Kathryn Hefner, Judith Feinberg, Radhika Kondapaka, Daniel J. Feaster, et al. "Suicidality as a Predictor of Overdose among Patients with Substance Use Disorders." Journal of Clinical Medicine 11, no. 21 (October 29, 2022): 6400. http://dx.doi.org/10.3390/jcm11216400.
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Increasing rates of overdose and overdose deaths are a significant public health problem. Research has examined co-occurring mental health conditions, including suicidality, as a risk factor for intentional and unintentional overdose among individuals with substance use disorder (SUD). However, this research has been limited to single site studies of self-reported outcomes. The current research evaluated suicidality as a predictor of overdose events in 2541 participants who use substances enrolled across eight multi-site clinical trials completed within the National Drug Abuse Treatment Clinical Trials Network between 2012 to 2021. The trials assessed baseline suicidality with the Concise Health Risk Tracking Self-Report (CHRT-SR). Overdose events were determined by reports of adverse events, cause of death, or hospitalization due to substance overdose, and verified through a rigorous adjudication process. Multivariate logistic regression was performed to assess continuous CHRT-SR score as a predictor of overdose, controlling for covariates. CHRT-SR score was associated with overdose events (p = 0.03) during the trial; the likelihood of overdose increased as continuous CHRT score increased (OR 1.02). Participants with lifetime heroin use were more likely to overdose (OR 3.08). Response to the marked rise in overdose deaths should integrate suicide risk reduction as part of prevention strategies.
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Gunnell, D. "Medical management of deliberate drug overdose: A neglected area for suicide prevention?" Emergency Medicine Journal 21, no. 1 (January 1, 2004): 35–38. http://dx.doi.org/10.1136/emj.2003.000935.
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Moore, DF, DF Wood, and GN Volans. "Erratum to: Features, prevention and management of acute overdose due to antidiabetic drugs. Drug Saf." Drug Safety 11, no. 3 (September 1994): 212. http://dx.doi.org/10.1007/bf03257465.
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Speight, Carly C., Bobbi J. Stoner, George A. Guthrie, Turkeisha S. Brown, Claire E. Farel, M. Patricia Rivera, and Asher J. Schranz. "972. Infection and Overdose Prevention for Persons with Injection Drug Use-Related Infections: Evaluation of an Inpatient Quality Improvement Program." Open Forum Infectious Diseases 7, Supplement_1 (October 1, 2020): S515. http://dx.doi.org/10.1093/ofid/ofaa439.1158.
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Abstract Background Hospitalizations for injection drug use-related infections (IDU-I) are increasing in North Carolina and nationally. Many IDU-I, such as endocarditis, bone, joint, and spine infections, require long antimicrobial courses and extended inpatient stays. These hospitalizations are opportunities to engage patients in overdose and infection prevention. Methods A quality improvement (QI) program was piloted for inpatients with IDU-I. Eligible patients admitted to the inpatient pulmonary or infectious disease teams from 11/2019 to 01/2020 were referred to the QI team if they reported or were suspected to have injected drugs over the past year, or felt to benefit from drug-related infection prevention and overdose services. A checklist of recommendations to the care teams included: (1) screening for HIV, Hepatitis B (HBV) and C (HCV), (2) immunization for Hepatitis A (HAV), HBV, and tetanus, (3) prescription of naloxone at discharge, and (4) information on a syringe services program in or near their county. After review of the medical record, the QI team made recommendations on the appropriate taks from the checklist. The number of QI checklist tasks performed on the two inpatient teams during a 9-week pilot period (the above period excepting a two-week break) was reviewed. Baseline comparison data was not incorporated, owing to the challenges in retrospective identification of IDU-I. Results 20 patients were included in the intervention. The median age was 32 years (IQR 27-38) and 70% were female. The most common diagnosis was endocarditis (40%) and the median length of stay was 11 days (IQR 5-42). HIV and HCV tests were each conducted in 95% of patients (Table). Screenings for HAV and HBV immunity were done in 90% of patients. HAV, HBV, and Tdap immunizations were given to 20%, 35%, and 50%, respectively. Naloxone was provided to 60% of patients at discharge and half of patients were referred to syringe programs. HCV was detected in 8 patients and HBV in 2 patients. No patients were diagnosed with HIV. Percentage of infection and overdose prevention services provided to eligible IDU-I patients during hospitalization. Conclusion In a setting without comprehensive addiction consultation, a simple intervention provided guideline-concordant infection and overdose prevention services for persons hospitalized for IDU-I. Disclosures All Authors: No reported disclosures
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Nguyen, Duy Q., Brian Chung, Loryn L. Osburn, Mark A. Della Paolera, and Benjamin Chavez. "Utilization of Pharmacists in Addressing Medication Abuse in the Pacific Northwest." Journal of Pharmacy Practice 30, no. 5 (June 9, 2016): 528–33. http://dx.doi.org/10.1177/0897190016652066.
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Objective: This article aims to explore the statistics observed in the Pacific Northwest regarding substance abuse, as Oregon and Washington have been shown to be most affected given the increased treatment admissions for opioid utilization and mortality related to medication overdose. Methods: Using PubMed and National Conference of State Legislatures database, articles detailing prescription drug abuse statistics, programs, and laws were collected and analyzed in order to identify possible solutions. Summary: Many studies report that pain medication prescriptions have seen a rise in recent years, however, there still exists an inadequacy in pain management. This increase in prescriptions may also contribute to the rising number in substance misuse and subsequently overdose deaths. Pharmacists can have a global effect on abuse prevention if certain monitoring strategies are implemented and enforced. Conclusion: Health-care providers and pharmacists should contribute to abuse prevention by helping to detect fraudulent prescriptions, staying up to date with current guidelines, and being aware of new safety programs such as prescription drug monitoring programs (PDMPs).
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Dragisic, Tatjana, Mirjana Jovanovic, Aleksandra Dickov, Tamara Bugarski, Olga Ivetic, and Mirjana Miskovic. "Heroin overdose - suicide or accident?" Vojnosanitetski pregled 75, no. 9 (2018): 905–10. http://dx.doi.org/10.2298/vsp161212025d.
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Background/Aim. Suicide is a public health problem. Due to frequent overdose among drug addicts, there is a question about suicidality in this population. The aim of this study is to determine the specificity and distinctive factors in opiate addicts who have overdosed with an intention to commit suicide compared to addicts who have overdosed accidentally. Methods. The survey included 150 heroin addicts who were in the substitution program: 49 subjects who overdosed with a clear suicidal intention and 101 addicts who overdosed without suicidal intention. The subjects filled out the questionnaire about socio-demographic data and data regarding their addiction, the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) as well as the Manchester Short Assessment of Quality of Life (MANSA) questionnaire about the quality of life. For statistical analysis, Pearson's ?2 test, Student t-test and univariate variance analysis were used. Results. The addicts who attempted suicide w?re younger persons (29.7 vs. 36.3 years of age), started to take heroin earlier (17.8 vs. 21.3 years of age; p= 0.013), they use it for a longer period (14.1 vs. 9.2 years; p = 0.00) and take it intravenously for a longer period (11.6 vs. 6.5 years; p = 0.00). The suicide was preceded by a traumatic event (p = 0.015) and there were several attempts of suicide (p = 0.004). The quality of life regarding accommodation, friends and organization of their free time was assessed as not so good (p = 0.03). Conclusion. In accordance with the obtained data, it is necessary to design programs for the prevention of suicide among addicts in general and especially programs that would be aimed at younger addicts.
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Wagner, Karla D., Peter J. Davidson, Ellen Iverson, Rachel Washburn, Emily Burke, Alex H. Kral, Miles McNeeley, Jennifer Jackson Bloom, and Stephen E. Lankenau. "“I felt like a superhero”: The experience of responding to drug overdose among individuals trained in overdose prevention." International Journal of Drug Policy 25, no. 1 (January 2014): 157–65. http://dx.doi.org/10.1016/j.drugpo.2013.07.003.
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Lowder, Evan Marie, Joseph Amlung, and Bradley R. Ray. "Individual and county-level variation in outcomes following non-fatal opioid-involved overdose." Journal of Epidemiology and Community Health 74, no. 4 (January 9, 2020): 369–76. http://dx.doi.org/10.1136/jech-2019-212915.
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BackgroundA lack of large-scale, individually linked data often has impeded efforts to disentangle individual-level variability in outcomes from area-level variability in studies of many diseases and conditions. This study investigated individual and county-level variability in outcomes following non-fatal overdose in a state-wide cohort of opioid overdose patients.MethodsParticipants were 24 031 patients treated by emergency medical services or an emergency department for opioid-involved overdose in Indiana between 2014 and 2017. Outcomes included repeat non-fatal overdose, fatal overdose and death. County-level predictors included sociodemographic, socioeconomic and treatment availability indicators. Individual-level predictors included age, race, sex and repeat non-fatal opioid-involved overdose. Multilevel models examined outcomes following non-fatal overdose as a function of patient and county characteristics.Results10.9% (n=2612) of patients had a repeat non-fatal overdose, 2.4% (n=580) died of drug overdose and 9.2% (n=2217) died overall. Patients with a repeat overdose were over three times more likely to die of drug-related causes (OR=3.68, 99.9% CI 2.62 to 5.17, p<0.001). County-level effects were limited primarily to treatment availability indicators. Higher rates of buprenorphine treatment providers were associated with lower rates of mortality (OR=0.82, 95% CI 0.68 to 0.97, p=0.024), but the opposite trend was found for naltrexone treatment providers (OR=1.20, 95% CI 1.03 to 1.39, p=0.021). Cross-level interactions showed higher rates of Black deaths relative to White deaths in counties with high rates of naltrexone providers (OR=1.73, 95% CI 1.09 to 2.73, p=0.019).ConclusionAlthough patient-level differences account for most variability in opioid-related outcomes, treatment availability may contribute to county-level differences, necessitating multifaceted approaches for the treatment and prevention of opioid abuse.
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Noroozi, Mehdi, Peter Higgs, Azadeh Bayani, Bahram Armoon, Ali Nazeri Astaneh, Ladan Fattah Moghaddam, and Mohammad Askari. "Non -fatal overdose among people who inject drugs in Tehran, Iran." Substance Abuse Treatment, Prevention, and Policy 15, no. 1 (October 14, 2020). http://dx.doi.org/10.1186/s13011-020-00323-0.
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Abstract Background With increasing frequencies of non-fatal overdose in people who inject drugs (PWID), it is essential to improve our knowledge about associated risk factors for overdose to inform overdose prevention and assistance programs. The aim of present study was to determine the prevalence of non-fatal overdose and the associated risk factors among PWID in Tehran, Iran. Methods Snowball sampling was used to collect data from 465 participants in Tehran using a cross-sectional survey. Consenting participants who reported drug injecting in the past month and were able to speak and comprehend Farsi enough to respond to survey questions were interviewed. The endpoint of interest was non-fatal overdose in the previous 6 months, or answering “Yes” to the question: “In the last six months, have you ever overdosed by accident? (at least once)”. We used STATA v. 14 for this analysis. Statistical significance was defined as p < 0.05 for all analyses. Results Of 465 PWIDs who participated in this study, all were male, and about half had less than a high school education. The prevalence of self-reported non-fatal overdose in the past 6 months was 38% (CI95%: 34, 43%). Our findings indicate that characteristics and behaviors that were associated with an increased risk of experiencing an overdose in the past 6 months were drug use initiation under 22 years (AOR =2.2, P < 0.05), using methamphetamine (AOR =2.8, P < 0.05), and using multiple drugs at the same time (AOR =2.1, P < 0.05). Also, more recent initiates to injecting (< 2 years) had an increased risk of experiencing an overdose in the past 6 months. The odds of experiencing a non-fatal overdose among PWIDs who regularly attended NSP were 0.6 times less than for those who did not attend regularly (OR = 0.6,95% CI: 0.2–0.9). Conclusion Methamphetamine and alcohol use were the most significant association for non-fatal overdose among PWIDs. Our results indicate that intervention and prevention initiatives seeking to reduce overdoses among PWIDs should not only be focused on the primary drug used but also the use of alcohol and poly-drug use.
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Jacquemin, Bretta, Teresa Hamby, and Stella Tsai. "Using probabilistic matching to improve opioid drug overdose surveillance, New Jersey." Online Journal of Public Health Informatics 11, no. 1 (May 30, 2019). http://dx.doi.org/10.5210/ojphi.v11i1.9774.
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ObjectiveLink syndromic surveillance data for potential opioid-involved overdoses with hospital discharge data to assess positive predictive value of CDC Opioid Classifiers for conducting surveillance on acute drug overdoses.IntroductionThe opioid drug overdose crisis presents serious challenges to state-based public health surveillance programs, not the least of which is uncertainty in the detection of cases in existing data systems. New Jersey historically had slightly higher unintentional drug overdose death rates than the national average, but by 2001 dramatic increases in drug overdose deaths in states like West Virginia began to drive up the national rate (Figure 1). Although the rise in New Jersey’s fatal overdose rates has mirrored the national rate since 1999, the rate has dramatically increased since 2011- from 9.7 per 100,000 (868 deaths) to 21.9 per 100,000 in 2016 (1,931 deaths), an increase of 125% in five years.1The New Jersey Department of Health has been funded by the Centers for Disease Control and Prevention (CDC) to conduct surveillance of opioid-involved overdoses through the Enhanced Surveillance of Opioid-Involved Overdose in States (ESOOS) program, and to conduct syndromic surveillance through the National Syndromic Surveillance Program (NSSP); this has presented a collaboration opportunity for the Department’s surveillance grantee programs to use existing resources to evaluate and refine New Jersey’s drug overdose case definitions and develop new indicators to measure the burden of overdose throughout the state and to facilitate effective responses.MethodsThis work examined using probabilistic matching strategies to assess how accurately syndromic surveillance data identifies potential opioid-involved overdose patients by linking to hospital discharge records after subsequent treatment in an emergency department or inpatient setting for either a confirmed opioid-involved overdose or another condition(s).New Jersey syndromic surveillance data from NSSP’s ESSENCE system from December 2016 with either CDC’s CCDD Classifiers “CDC Opioid Overdose V1” or “CDC Heroin Overdose V3” were selected for inclusion (“NJ ESSENCE data”). NJ ESSENCE data were restructured to produce one record per patient visit, with each record assigned one or more overdose classifiers; these records were then matched to the universe of acute care hospital discharge billing records from the New Jersey Hospital Discharge Data System (“UB data”) from the same time period. Confirmed drug overdoses were flagged in the UB data by using the CDC’s baseline ESOOS case definition, which searches all diagnosis fields for ICD-10-CM codes indicating an unintentional or undetermined intent drug overdose, an opioid overdose, or a heroin overdose. Optionally, there are suggested codes for mental and behavioral health conditions that indicate opioid abuse or dependence with intoxication (Table 1).Using SAS® software and PROC SQL, data were matched using a three-round “blocking” strategy based on facility identifier and admission date, and combinations of date of birth, sex, patient ZIP code, and age. Concordance of ESSENCE opioid overdose classifiers with indicator categories used by CDC’s ESOOS was evaluated. Suspected opioid overdoses from NJ ESSENCE that matched to UB records for mental health conditions that were not also acute overdoses were reviewed.ResultsThere were 253 records in NJ ESSENCE data with either “CDC Opioid Overdose V1” or “CDC Heroin Overdose V3” CCDD classifiers; restructuring the data resulted in 149 unique records of potential opioid overdoses. Of these, 106 (71%) records from NJ ESSENCE were successfully matched to emergency department or inpatient records. Eighty (80) records (54%), were matched in the first round using facility identifier and date of admission, date of birth, sex, and patient’s home ZIP code. Of the 43 unmatched NJ ESSENCE records, 33 (77%) were patients missing age and date of birth.Of the 106 matched records (Table 2):● 74 opioid-involved overdoses in NJ ESSENCE matched to any drug overdose records in the UB data, for an overall PPV of 70%.● 69 opioid-involved overdoses in NJ ESSENCE matched to opioid-involved overdose records, for an opioid-involved PPV of 65%.● 54 heroin-involved overdoses in NJ ESSENCE matched to heroin-involved overdose records, for a heroin-involved PPV of 92%.32 matched records were NJ ESSENCE positive for opioids and UB negative, and 24 (75%) were classified as potential heroin overdoses.●18 records had at least one mental and behavioral health condition code as part of the final discharge record.● 3 were flagged with the mental and behavioral health conditions with opioid intoxication indicator.Only one record appeared to be a possible false positive, with an NJ ESSENCE record indicating a “suspected heroin overdose or an overdose by unspecified drugs and of undetermined intent”, but a discharge record indicated a primary diagnosis code of I46.9 (sudden cardiac arrest) and other systemic diagnoses but no poisoning or mental or behavioral health codes reported.ConclusionsNJ ESSENCE data with CDC Opioid or Heroin Overdose Classifiers was able to correctly identify opioid-involved overdoses in matched records for patients experiencing an acute overdose better than 2 out of 3 times. For patients experiencing an acute heroin overdose the PPV was over 90%. Cases with discordance in classification matched to records that may have been possible undetected drug intoxications or other mental and behavioral health conditions.This work does not confirm that the CDC Opioid or Heroin Overdose Classifiers accurately capture all or even most drug overdoses treated in New Jersey hospitals reported to NSSP ESSENCE as of December 2016. A total of 1,461 discharges for acute drug overdoses were identified in UB data using the ESOOS case definition; 1,069 were treated and released from the emergency department, and 392 were admitted for further inpatient care. The 106 matched records only represent 7% of total overdose records identified in the UB data.Further suggested work includes follow-up on possible data quality issues, pursuing a comprehensive project using all UB-identified overdoses matched to a broader selection of NJ ESSENCE data to examine what may be missed by the CDC’s NSSP overdose classifiers, and using more recent data to test improvements made to the system since the original data pull.References1. Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. Web-based Injury Statistics Query and Reporting System (WISQARS) [online]. (2005) [2018 Oct 1]. Available from URL: http://www.cdc.gov/injury/wisqars
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Helmick, Raven. "Drug Overdose Trends among Black Indiana Residents: 2013-2017." Online Journal of Public Health Informatics 11, no. 1 (May 30, 2019). http://dx.doi.org/10.5210/ojphi.v11i1.9916.
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ObjectiveTo understand trends in race-specific mortality rates between blacks and whites to discover any racial inequalities that might exist for drug overdose deaths. To delve into the types of drugs that are prominently involved in black drug overdose deaths from 2013-2017 in the state of Indiana.IntroductionBlack Hoosiers, the largest minority population in Indiana, make up almost 10% of the state’s population, and accounted for 8% of the total resident drug overdose deaths from 2013-2017 compared to whites at 91%. However, a closer look at race-specific mortality rates might reveal racial inequalities. Therefore, the purpose of this project was to analyze drug overdose morality rates among white and black Hoosiers to discover possible racial inequalities and to discover trends in drug involvement in overdose deaths among blacks.MethodsDrug overdose deaths that occurred in Indiana between 2013 and 2017 were identified using the underlying and contributing cause of death ICD-10 codes and abstracted from the Indiana State Department of Health’s annual finalized mortality dataset. Race-specific drug overdose death rates were calculated and compared among racial groups. Drug overdose deaths in blacks were examined for trends over time and by the types of drugs involved.ResultsBetween 2013 and 2017, drug overdose mortality rates for whites increased from 17.05 to 27.28 per 100,000. Blacks saw a higher rate increase during this same time frame: from 10.74 to 30.62 per 100,000, surpassing the mortality rate of whites by the end of 2017. Drug overdose deaths in blacks increased 197% from 2013-2017 and drug specific mortality rate increases were seen across all drug category’s. Opioids, which were involved in 61% of the 2017 drug overdose deaths among blacks, had a rate increase from 3.05 to 18.62 per 100,000 between 2013 and 2017. Drug specific overdose mortality rate increases were also seen for overdoses involving cocaine (1.76 to 10.62 per 100,000), benzodiazepines (0.32 to 3.08 per 100,000), and psychostimulants other than cocaine (0.16 to 1.69 per 100,000) such as amphetamines.ConclusionsWhile white Hoosiers had higher drug overdose mortality rates between 2013 and 2016, black Hoosiers had a greater mortality rate increase and surpassed the mortality rate in whites in 2017. Opioids, the most frequently involved substance in overdose deaths among blacks from 2013-2017, showed increasing rates during this time period. However, increases in drug specific overdose mortality rates for cocaine, benzodiazepines, and psychostimulants other than cocaine also call for public health attention. These results promote the inclusion of minority health experts in drug overdose prevention efforts and issue a call for future prevention efforts to be targeted toward the state’s largest minority population.
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Robinson, Amber B., Nida Ali, Olga Costa, Cherie Rooks-Peck, Amy Sorensen-Alawad, Jonathan Ballard, Kathryn Lowerre, and Anna Fondario. "A Thematic Analysis of Overdose Prevention and Response Efforts in States Experiencing Declines in Rates of Opioid-Involved Overdose Deaths." Public Health Reports, June 29, 2021, 003335492110268. http://dx.doi.org/10.1177/00333549211026816.
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Objective To address the opioid overdose epidemic, it is important to understand the broad scope of efforts under way in states, particularly states in which the rate of opioid-involved overdose deaths is declining. The primary objective of this study was to examine core elements of overdose prevention activities in 4 states with a high rate of opioid-involved overdose deaths that experienced a decrease in opioid-involved overdose deaths from 2016 to 2017. Methods We identified 5 states experiencing decreases in age-adjusted mortality rates for opioid-involved overdoses from 2016 to 2017 and examined their overdose prevention programs via program narratives developed with collaborators from each state’s overdose prevention program. These program narratives used 10 predetermined categories to organize activities: legislative policies; strategic planning; data access, capacity, and dissemination; capacity building; public-facing resources (eg, web-based dashboards); training resources; enhancements and improvements to prescription drug monitoring programs; linkage to care; treatment; and community-focused initiatives. Using qualitative thematic analysis techniques, core elements and context-specific activities emerged. Results In the predetermined categories of programmatic activities, we identified the following core elements of overdose prevention and response: comprehensive state policies; strategic planning; local engagement; data access, capacity, and dissemination; training of professional audiences (eg, prescribers); treatment infrastructure; and harm reduction. Conclusions The identification of core elements and context-specific activities underscores the importance of implementation and adaptation of evidence-based prevention strategies, interdisciplinary partnerships, and collaborations to address opioid overdose. Further evaluation of these state programs and other overdose prevention efforts in states where mortality rates for opioid-involved overdoses declined should focus on impact, optimal timing, and combinations of program activities during the life span of an overdose prevention program.