A Chronic Condition Disguised as an Acute Event: the Case for Re-thinking Stimulant Overdose Death

Riley, Elise D.; Hsue, Priscilla Y.; Coffin, Phillip O.

doi:10.1007/s11606-022-07692-1

Cited by 11 publications

(13 citation statements)

References 20 publications

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“…It also extends prior studies reporting that cocaine use stands out from other substances as being strongly associated with cardiac injury, small vessel disease, and fatal overdose in women experiencing homelessness and unstable housing ( Riley et al, 2013 , 2020, 2021). Taken together, the existing evidence suggests that incorporating routine assessment of stimulant use—particularly cocaine use—as a core risk factor for cardiovascular and cerebrovascular events during health care encounters, and intensive hypertension management when appropriate, may reduce morbidity and mortality in this population ( Riley et al, 2022 ).…”

Section: Discussionmentioning

confidence: 99%

Multiple substance use and blood pressure in women experiencing homelessness

Suen

Vittinghoff

et al. 2023

Addictive Behaviors Reports

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Section: Discussionmentioning

confidence: 99%

Multiple substance use and blood pressure in women experiencing homelessness

Suen

Vittinghoff

et al. 2023

Addictive Behaviors Reports

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“… 41 These data point to the need for CVD interventions for people with SUDs and to the need for STUD to be treated with long-term preventative interventions. 42 There are interventions that could be more widely implemented immediately to address existing gaps in care. For example, stimulant use is a known risk factor for CVD; however, substance use is generally absent from CVD risk assessments and treatment plans.…”

Section: Discussionmentioning

confidence: 99%

“…For example, stimulant use is a known risk factor for CVD; however, substance use is generally absent from CVD risk assessments and treatment plans. 42 Furthermore, despite evidence that β-blockers are a safe and effective intervention for heart failure among people who use cocaine 43,44 their use in this population is often avoided, due in part to stigma and misinformation. 45 Consistent with prior studies, 11 NFOD events made up approximately 94% of all overdose events in this study and the incidence of NFOD was more than 15 times that of fatal events.…”

Section: Discussionmentioning

confidence: 99%

“…Cardiovascular disease (CVD) is common among patients with STUD and recent population-level analyses in BC show that overdose is associated with increased CVD risk . These data point to the need for CVD interventions for people with SUDs and to the need for STUD to be treated with long-term preventative interventions . There are interventions that could be more widely implemented immediately to address existing gaps in care.…”

Section: Discussionmentioning

confidence: 99%

“…There are interventions that could be more widely implemented immediately to address existing gaps in care. For example, stimulant use is a known risk factor for CVD; however, substance use is generally absent from CVD risk assessments and treatment plans . Furthermore, despite evidence that β-blockers are a safe and effective intervention for heart failure among people who use cocaine their use in this population is often avoided, due in part to stigma and misinformation …”

Section: Discussionmentioning

confidence: 99%

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Association of Opioid and Stimulant Use Disorder Diagnoses With Fatal and Nonfatal Overdose Among People With a History of Incarceration

et al. 2022

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ImportanceStudies have suggested a rise in opioid- and stimulant-involved overdoses in recent years in North America. This risk may be acute for individuals who have had contact with the criminal justice system, who are particularly vulnerable to overdose risk.ObjectiveTo examine the association of opioid and/or stimulant use disorder diagnoses with overdose (fatal and nonfatal) among people with histories of incarceration.Design, Setting, and ParticipantsIn this cohort study, population-based health and corrections data were retrieved from the British Columbia Provincial Overdose Cohort, which contains a 20% random sample of residents of British Columbia. The analysis included all people in the 20% random sample who had a history of incarceration between January 1, 2010, and December 31, 2014. Outcomes were derived from 5-years of follow-up data (January 1, 2015, to December 31, 2019). Statistical analysis took place from January 2022 to June 2022.ExposuresSubstance use disorder diagnosis type (ie, opioid use disorder, stimulant use disorder, both, or neither), sociodemographic, health, and incarceration characteristics.Main Outcomes and MeasuresHazard ratios (HRs) are reported from an Andersen-Gill model for recurrent nonfatal overdose events and from a Fine and Gray competing risk model for fatal overdose events.ResultsThe study identified 6816 people (5980 male [87.7%]; 2820 aged &lt;30 years [41.4%]) with histories of incarceration. Of these, 293 (4.3%) had opioid use disorder only, 395 (6.8%) had stimulant use disorder only, and 281 (4.1%) had both diagnoses. During follow-up, 1655 people experienced 4026 overdoses including 3781 (93.9%) nonfatal overdoses, and 245 (6.1%) fatal overdoses. In adjusted analyses, the hazard of both fatal (HR, 2.39; 95% CI, 1.48-3.86) and nonfatal (HR, 2.45; 95% CI, 1.94-3.11) overdose was highest in the group with both opioid and stimulant use disorder diagnoses.Conclusions and RelevanceThis cohort study of people with a history of incarceration found an elevated hazard of fatal and nonfatal overdose among people with both opioid and stimulant use disorder diagnoses. This study suggests an urgent need to address the service needs of individuals who have had contact with the criminal justice system and who co-use opioids and stimulants.

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Presentation and Outcomes of Adults With Overdose-Related Out-of-Hospital Cardiac Arrest

Yogeswaran,

Drucker,

Kume

et al. 2023

JAMA Netw Open

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ImportanceDrug overdose (OD) is a public health challenge and an important cause of out-of-hospital cardiac arrest (OHCA). Existing studies evaluating OD-related OHCA (OD-OHCA) either aggregate all drugs or focus on opioids. The epidemiology, presentation, and outcomes of drug-specific OHCA are largely unknown.ObjectiveTo evaluate the temporal pattern, clinical presentation, care, and outcomes of adult patients with OHCA overall and according to the drug-specific profile.Design, Setting, and ParticipantsThis cohort study of adults with OHCA in King County Washington was conducted between January 1, 2015, and December 31, 2021. Etiology of OHCA was determined using emergency medical service, hospital, and medical examiner records. Etiology was classified as non-OD OHCA or OD-OHCA, with drug-specific profiles categorized as (1) opioid without stimulant, (2) stimulant without opioid, (3) opioid and stimulant, or (4) all other nonstimulant, nonopioid drugs. Statistical analysis was performed on July 1, 2023.ExposureOut-of-hospital cardiac arrest.Main Outcomes and MeasuresThe primary outcome was survival to hospital discharge. The secondary outcome was survival with favorable functional status defined by Cerebral Performance Category 1 or 2 based on review of the hospital record.ResultsIn this cohort study, there were 6790 adult patients with emergency medical services–treated OHCA from a US metropolitan system. During the 7-year study period, there were 702 patients with OD-OHCA (median age, 41 years [IQR, 29-53 years]; 64% male [n = 450] and 36% female [n = 252]) and 6088 patients with non-OD OHCA (median age, 66 years [IQR, 56-77 years]; 65% male [n = 3944] and 35% female [n = 2144]). The incidence of OD-OHCA increased from 5.2 (95% CI, 3.8-6.6) per 100 000 person-years in 2015 to 13.0 (95% CI, 10.9-15.1) per 100 000 person-years in 2021 (P &lt; .001 for trend), whereas there was no significant temporal change in the incidence of non-OD OHCA (P = .30). OD-OHCA were more likely to be unwitnessed (66% [460 of 702] vs 41% [2515 of 6088]) and less likely to be shockable (8% [56 of 702] vs 25% [1529 of 6088]) compared with non-OD OHCA. Unadjusted survival was not different (20% [138 of 702] for OD vs 18% [1095 of 6088] for non-OD). When stratified by drug profile, combined opioid-stimulant OHCA demonstrated the greatest relative increase in incidence. Presentation and outcomes differed by drug profile. Patients with stimulant-only OHCA were more likely to have a shockable rhythm (24% [31 of 129]) compared with patients with opioid-only OHCA (4% [11 of 295]) or patients with combined stimulant-opioid OHCA 5% [10 of 205]), and they were more likely to have a witnessed arrest (50% [64 of 129]) compared with patients with OHCA due to other drugs (19% [14 of 73]) or patients with combined stimulant-opioid OHCA (23% [48 of 205]). Patients with a combined opioid-stimulant OHCA had the lowest survival to hospital discharge (10% [21 of 205]) compared with patients with stimulant-only OHCA (22% [29 of 129]) or patients with OHCA due to other drugs (26% [19 of 73]), a difference that persisted after multivariable adjustment.Conclusions and RelevanceIn a population-based cohort study, the incidence of OD-OHCA increased significantly from 2015 to 2021, with the greatest increase observed among patients with a combined stimulant-opioid OHCA. Presentation and outcome differed according to the drug-specific profile. The combination of increasing incidence and lower survival among among patients with a opioid-stimulant OHCA supports prevention and treatment initiatives that consider the drug-specific profile.

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A Chronic Condition Disguised as an Acute Event: the Case for Re-thinking Stimulant Overdose Death

Cited by 11 publications

References 20 publications

Multiple substance use and blood pressure in women experiencing homelessness

Multiple substance use and blood pressure in women experiencing homelessness

Association of Opioid and Stimulant Use Disorder Diagnoses With Fatal and Nonfatal Overdose Among People With a History of Incarceration

Presentation and Outcomes of Adults With Overdose-Related Out-of-Hospital Cardiac Arrest

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