Medical encounters for opioid-related intoxications in Southern Nevada: sociodemographic and clinical correlates

Abstract

BackgroundDespite today’s heightened concern over opioid overdose, the lack of population-based data examining clinical and contextual factors associated with opioid use represents a knowledge gap with relevance to prevention and treatment interventions. We sought to quantify rates of emergency department (ED) visits and inpatient hospitalizations for harmful opioid effects and their sociodemographic differentials as well as clinical correlates in Southern Nevada, using ED visit and hospital inpatient discharge records from 2011 to 2013.MethodsCases were identified by ICD-9-CM diagnosis codes for opioid poisoning and opioid-type drug dependence and abuse as well as poisoning and adverse effect E-codes. Comorbid conditions, including pain-related diagnoses, major chronic diseases, affective disorders, sleep disorders, sexually transmitted infections and viral hepatitis were assessed from all available diagnosis fields. Counts by age-race per zip code were modeled by negative binomial regression. Opioid injuries were further examined as a function both of neighborhood income and individual characteristics, with mixed-effects logistic regression to estimate the likelihood for an adverse outcome.ResultsOpioid intoxications and comorbidities were more common in low-income communities. The multivariable-adjusted rate for opioid-related healthcare utilization was 42 % higher in the poorest vs. richest quartile during the study period. The inter-quartile (quartile 1 vs. 4) rate increases for chronic bodily pains (44 %), hypertension (89 %), renal failure/diabetes (2.6 times), chronic lower respiratory disease (2.2 times), and affective disorders (57 %) were statistically significant. Chronic disease comorbidity was greater among non-Hispanic blacks, whereas abuse/dependence related disorders, alcohol or benzodiazepine co-use, chronic bodily pains, and affective disorders were more prevalent among non-Hispanic whites than nonwhites.ConclusionsThere were consistent patterns of disparities in healthcare utilization across sociodemographic groups for opioid-associated disorders. Further initiatives to evaluate the determinants of overdose and abuse and to implement targeted response efforts are needed.

Evaluation of Opioid Prescribing Habits Based on Analysis of a State Prescription Drug Monitoring Program

“…Several studies using alternative data sources have corroborated our findings of lower opioid prescribing rates in non-white populations (21)(22)(23)(24)(25)(26), although one study did find higher opioid prescribing in non-white and rural populations (27). One study showed higher rates of disorders related to opioid abuse and dependence (e.g., alcohol abuse, benzodiazepine use, affective disorders, sleep disorders) in white populations compared with non-white populations, yet simultaneously higher rates of opioid adverse effects and accidental poisonings in non-white populations (21). Also, hospitalizations for opioid and heroin poisoning were shown to be more likely in lower-income white populations (28).…”

“…Other studies have found that language barriers are a common source of disparity in health care access (19,20). Finally, factors such as sociological or cultural differences in pain perception and communication behaviors with health care providers could impact the observed disparities (21).…”

“…Also, hospitalizations for opioid and heroin poisoning were shown to be more likely in lower-income white populations (28). Lower income may also be a risk factor for opioid intoxication (21) and poisoning (29). Additionally, low-income rural populations showed that a co-diagnosis of depression more than tripled the likelihood that a patient would also have a prescription for opioids (30).…”

Expanding low-threshold buprenorphine to justice-involved individuals through mobile treatment: Addressing a critical care gap

“…While this crisis has impacted all sectors of society, historically marginalized groups, including those who are involved in the criminal justice system, continue to suffer disproportionately from opioid use disorder (OUD) and its consequences. Having justice involvement, along with other vulnerabilities such as having mental health conditions or experiencing poverty and homelessness, increases risk for overdose (Feng, Iser, & Yang, 2016; Hasegawa, Brown, Tsugawa, & Camargo, 2014) and exacerbates other negative outcomes such as risk of infectious disease (Galea & Vlahov, 2002). Fortunately, treatment with opioid agonist medications, such as buprenorphine and methadone, has been shown to significantly reduce illicit opioid use and many adverse correlates of its use, such as overdose and HIV transmission (Connery, 2015; Veilleux, Colvin, Anderson, York, & Heinz, 2010).…”

Psychotropic and Opioid-Based Medication Use among Economically Disadvantaged African-American Older Adults

“…Furthermore, opioid-related mortalities are sharply increasing among African Americans, exceeding the rates of Whites in some regions of the United States [ 10 , 11 ]. A recent study of opioid intoxications utilizing the emergency department revealed that African-Americans had higher chronic disease morbidity compared to Whites [ 12 ]. Taken together, these pieces of evidence point to mismanagement of pain among older African-American adults.…”