Disentangling opioids-related overdose syndemics: a scoping review

Lang, James; Mendenhall, Emily; Koon, Adam D.

doi:10.1016/j.drugpo.2023.104152

Cited by 4 publications

(3 citation statements)

References 83 publications

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“…This provides further evidence of their strong ecological link and syndemic nature, exacerbating existing vulnerabilities such as PWUD’s lack of access to healthcare services, as well as limited surveillance and drug checking [ 23 , 24 , 45 – 47 ]. In a recent study of 21 jurisdictions within the CDC's State Unintentional Drug Overdose Reporting System (SUDORS), monthly rates of fentanyl mixed with xylazine (FMX) overdose deaths rose by nearly fourfold (from 2.9 to 10.9%) between January 2019 and June 2022 [ 46 ]. During this period, Maryland (27.7%), Connecticut (26.4%), and Pennsylvania (23.3%) had the highest monthly rates of fatal FMX overdoses [ 28 ].…”

Section: Resultsmentioning

confidence: 99%

Public health impact and harm reduction implications of xylazine-involved overdoses: a narrative review

Zhu

2023

Harm Reduct J

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Introduction Xylazine, an α2-adrenoceptor agonist sedative commonly used in veterinary medicine, is not approved for human use. Nevertheless, xylazine-involved overdose rates have surged in recent years, fueled by an increasingly toxic and synthetic illicit drug supply in North America. Methods This narrative review assessed major epidemiological trends in xylazine-involved overdoses in North America, aiming to identify harm reduction priorities. A literature search was conducted using four bibliographic databases (PubMed, Scopus, Embase, and ScienceDirect) and three preprint servers (medRxiv, bioRxiv, and Europe PMC) on May 28, 2023, to capture articles related to combinations of keywords such as “xylazine”, “opioid”, and “harm reduction”. Results Xylazine emerged as an adulterant in Puerto Rico in 2001, likely diverted from veterinary supplies. By the mid-2010s, it began proliferating across unregulated US drug markets, often contemporaneously with illicitly manufactured fentanyl (IMF), displaying characteristics of a syndemic. Initially concentrated in Northeastern regions (e.g., Philadelphia, Connecticut, Maryland), xylazine-involved overdoses later extended to the Rust Belt, Southern, and Western regions of the USA in the late 2010s and early 2020s. During this time, xylazine-involved overdoses also surged in Canada, particularly in Western provinces (British Columbia and Alberta) and Ontario with established IMF-dominated unregulated drug markets. Discussion Over the past two decades, xylazine-involved overdoses have been rapidly rising in North America and exhibit few signs of slowing down, representing a serious public health epidemic. Numerous factors may have contributed to this, including limited epidemiological surveillance and drug checking for xylazine and emerging novel adulterants; further, barriers to comprehensive, trauma-informed, non-stigmatizing treatment and social services have also exacerbated this issue. While several epidemiological and ethnographic studies have assessed these factors in the USA, limited evidence is available in Canada where xylazine emerged more recently. This underscores the need for additional research and harm reduction measures. Conclusion Harm reduction-informed public health guidelines and programs are urgently needed to promote a safer supply, strengthen the healthcare system capacity to prevent and respond to xylazine-involved overdoses, and address social and structural disparities in health outcomes.

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Section: Resultsmentioning

confidence: 99%

Public health impact and harm reduction implications of xylazine-involved overdoses: a narrative review

Zhu

2023

Harm Reduct J

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“…violence experienced at a population or neighborhood level, including gun violence, health disparities, or arrest). Relatedly, Lang and colleagues ( 33 ) scoping review found an opportunity to research the connection of sociopolitical factors and structural forces, like violence (i.e. oppression) across macro systems (e.g.…”

Section: Introductionmentioning

confidence: 99%

“…oppression) across macro systems (e.g. healthcare, education, and housing), on interventions to address the consequences of substance use, including opioid overdose deaths ( 33 ). While dated, Goldstein’s ( 31 ) tripartite framework is the seminal research connecting violence and substance mis/use, differences in how violence is experienced among males and females, and is still applied to relevant research today ( 34 ).…”

Section: Introductionmentioning

confidence: 99%

Histories of violence among clients seeking substance use disorder treatment: a systematic mapping review

Beeler,

Gerrish,

Aldred

et al. 2024

Front. Psychiatry

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IntroductionThere is a limited literature base regarding the intersection of drug and alcohol treatment, violence, and trauma. While research substantiates that exposure to violence and trauma impacts the propensity to misuse substances, the conceptualization in clinical trials and practice has largely been narrow and gendered, referring only to intimate partner or domestic violence. Our systematic mapping review explored a more inclusive and expansive review of survivors of and perpetrators of violence and trauma (e.g., intimate partner violence, sexual assault, stalking, child abuse, political and community violence, criminal violence, micro violence, structural violence, and oppression) to establish: 1) the types of treatment settings included in intervention studies, 2) the common indicators of success or common outcomes recorded, and 3) understanding who is seeking treatment for drug and alcohol use with histories of violence.MethodsA systematic mapping review was conducted to identify any peer-reviewed articles published from 2011 to 2022. The Web of Science database was searched using a broad set of Boolean search terms related to violence, substance use disorders, and treatment. Over 8,800 records were identified from the systematic review with a total of 48 articles meeting inclusion criteria. ResultsMost studies in this review included populations reporting perpetration of violence (n=23, 48%) versus participants reporting survival of trauma/violence (n=17, 35%). Results also indicated female identifying populations (n=19; 40%) were predominantly served, were treated in the US (n=33; 69%) and seen in an outpatient setting (n=24; 50%). Authors also were attentive to studies that included sexual and gender minorities and discovered only three studies (6%) explicitly acknowledging inclusion of transgender participants or participants in relationship with partners of the same sex; three more studies (6%) were focused on participants with histories of or engaging in sex work. DiscussionThis review outlines treatment and research implications directly situated in the gap of service delivery found in this review. Specifically, the results elucidate the impact on minoritized and excluded identities based on gender, sexual preference, criminal legal status and directions for research and treatment to increase inclusion, representation, and equity across research and treatment settings.

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Chronic disease diagnoses and health service use among people who died of illicit drug toxicity in British Columbia, Canada

Palis,

Hu,

et al. 2024

BMC Med

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Background Illicit drug toxicity (i.e., overdose) is the leading cause of death in British Columbia (BC) for people aged 10–59. Stimulants are increasingly detected among drug toxicity deaths. As stimulant use and detection in deaths rises, it is important to understand how people who die of stimulant toxicity differ from people who die of opioid toxicity. Methods BC Coroners Service records were retrieved for all people who died of unintentional illicit drug toxicity (accidental or undetermined) between January 1, 2015, and December 31, 2019, whose coroner investigation had concluded and who had an opioid and/or stimulant detected in post-mortem toxicology and identified by the coroner as relevant to the death (N = 3788). BC Chronic Disease Registry definitions were used to identify people with chronic disease. Multinomial regression models were used to examine the relationship between chronic disease diagnoses and drug toxicity death type. Results Of the 3788 deaths, 11.1% (N = 422) had stimulants but not opioids deemed relevant to the cause of death (stimulant group), 26.8% (N = 1014) had opioids but not stimulants deemed relevant (opioid group), and 62.1% (N = 2352) had both opioids and stimulants deemed relevant (opioid/stimulant group). People with ischemic heart disease (1.80 (1.14–2.85)) and people with heart failure (2.29 (1.25–4.20)) had approximately twice the odds of being in the stimulant group as compared to the opioid group. Conclusions Findings suggest that people with heart disease who use illicit stimulants face an elevated risk of drug toxicity death. Future research should explore this association and should identify opportunities for targeted interventions to reduce drug toxicity deaths among people with medical comorbidities.

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Disentangling opioids-related overdose syndemics: a scoping review

Cited by 4 publications

References 83 publications

Public health impact and harm reduction implications of xylazine-involved overdoses: a narrative review

Public health impact and harm reduction implications of xylazine-involved overdoses: a narrative review

Histories of violence among clients seeking substance use disorder treatment: a systematic mapping review

Chronic disease diagnoses and health service use among people who died of illicit drug toxicity in British Columbia, Canada

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