The Future of the United States Overdose Crisis: Challenges and Opportunities

Cerdá, Magdalena; Krawczyk, Noa; Keyes, Katherine M.

doi:10.1111/1468-0009.12602

Cited by 4 publications

(8 citation statements)

References 145 publications

(238 reference statements)

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“…Further, to produce a sustainable and sizeable reduction in overdose rates, future research would benefit from investigating the potential for a whole-of-system approach to overdose prevention, 64 including primary prevention efforts that address the social determinants of drug use, such as job loss and affordable housing, as well as interventions that address mental health and socio-emotional development in childhood and adolescence. 65…”

Section: Discussionmentioning

confidence: 99%

Simulating the Simultaneous Impact of Medication for Opioid Use Disorder and Naloxone on Opioid Overdose Death in Eight New York Counties

Cerdá,

Hamilton,

Hyder

et al. 2024

Epidemiology

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Background: The United States is in the midst of an opioid overdose epidemic; 28.3 per 100,000 people died of opioid overdose in 2020. Simulation models can help understand and address this complex, dynamic, nonlinear social phenomenon. Using the HEALing Communities Study, aimed at reducing opioid overdoses, and an agent-based model, SiCLOPS (Simulation of Community-Level Overdose Prevention Strategy), we simulated increases in buprenorphine initiation and retention and naloxone distribution aimed at reducing overdose deaths by 40% in New York Counties. Methods: Our simulations covered 2020-2022. The eight counties contrasted urban or rural and high and low baseline rates of opioid use disorder treatment. The model calibrated agent characteristics for opioid use and use disorder, treatments and treatment access, and fatal and non-fatal overdose. Modeled interventions included increased buprenorphine initiation and retention, and naloxone distribution. We predicted decrease in the rate of fatal opioid overdose 1 year after intervention, given various modeled intervention scenarios. Results: Counties required unique combinations of modeled interventions to achieve 40% reduction in overdose deaths. Assuming a 200% increase in naloxone from current levels, high baseline treatment counties achieved 40% reduction in overdose deaths with a simultaneous 150% increase in buprenorphine initiation. In comparison, low baseline treatment counties required 250-300% increases in buprenorphine initiation coupled with 200-1,000% increases in naloxone, depending on the county. Conclusions: Results demonstrate the need for tailored county-level interventions to increase service utilization and reduce overdose deaths, as the modeled impact of interventions depended on the county’s experience with past and current interventions.

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Section: Discussionmentioning

confidence: 99%

Simulating the Simultaneous Impact of Medication for Opioid Use Disorder and Naloxone on Opioid Overdose Death in Eight New York Counties

Cerdá,

Hamilton,

Hyder

et al. 2024

Epidemiology

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“…Of the four tests discussed, only one method, the rapid immunoassay test strips, provides immediate results to the participant. This was deemed to be of utmost importance because supply-level data cannot come at the expense of individual-level information, especially when such information can be used to inform decision-making related to use and, ultimately, reduce overdose risk [ 12 , 14 , 16 , 20 , 21 ]. In the final three tests, small amounts (10 mg) of sample are required.…”

Section: Key Principlesmentioning

confidence: 99%

“…The USA faces a worsening overdose crisis, exacerbated by supply shifts and the emergence of xylazine, altering the risk environment for PWUD [ 3 , 7 , 8 ]. In the absence of safe supply, drug checking services are an urgent need [ 12 , 13 ], as these services provide PWUD with agency to navigate an unpredictable drug market [ 18 ]. Many SSPs and harm reduction programs distribute rapid immunoassay test strips, and community-academic partnerships provide a promising avenue to enhance existing drug checking services for supply-level monitoring, by developing and validating methods for analysis (e.g., xylazine test strips).…”

Section: Implications For Public Health Policy and Practicementioning

confidence: 99%

“…Amidst notable supply shifts observed over the course of the COVID-19 pandemic [ 11 ], drug checking services have been proposed as a crucial public health response to the overdose epidemic in the USA [ 12 – 16 ]. Drug checking services offer a promising strategy to improve knowledge and agency among PWUD navigating the opaque drug market [ 17 , 18 ].…”

Section: Introductionmentioning

confidence: 99%

“…Fentanyl test strips (FTS), which are used to detect the presence of fentanyl, are widely used among PWUD to make informed decisions about use and mitigate risks [ 19 ]. Existing evidence demonstrates that FTS may modify how individuals intend to use, prompting individuals to discard their sample or practice harm reduction techniques [ 12 ], such as using a tester shot, using less, using in the presence of others, using more slowly, or ensuring naloxone is accessible [ 14 , 16 , 20 – 22 ].…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Enhancing drug checking services for supply monitoring: perspectives on implementation in syringe service programs in the USA

Moon,

Whitehead,

Trinh

et al. 2024

Harm Reduct J

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Background Shifts in the US drug supply, including the proliferation of synthetic opioids and emergence of xylazine, have contributed to the worsening toll of the overdose epidemic. Drug checking services offer a critical intervention to promote agency among people who use drugs (PWUD) to reduce overdose risk. Current drug checking methods can be enhanced to contribute to supply-level monitoring in the USA, overcoming the selection bias associated with existing supply monitoring efforts and informing public health interventions. Methods As a group of analytical chemists, public health researchers, evaluators, and harm reductionists, we used a semi-structured guide to facilitate discussion of four different approaches for syringe service programs (SSPs) to offer drug checking services for supply-level monitoring. Using thematic analysis, we identified four key principles that SSPs should consider when implementing drug checking programs. Results A number of analytical methods exist for drug checking to contribute to supply-level monitoring. While there is likely not a one-size-fits-all approach, SSPs should prioritize methods that can (1) provide immediate utility to PWUD, (2) integrate seamlessly into existing workflows, (3) balance individual- and population-level data needs, and (4) attend to legal concerns for implementation and dissemination. Conclusions Enhancing drug checking methods for supply-level monitoring has the potential to detect emerging threats in the drug supply and reduce the toll of the worsening overdose epidemic.

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A Quantitative Examination of Illness Models Among People With Opioid Use Disorder Receiving Methadone Treatment

Gaeta Gazzola,

Carmichael,

Thompson

et al. 2024

J Addict Med

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Background Few studies have examined illness models among people with addiction. We investigated illness models and their associations with demographics and treatment beliefs among patients receiving methadone treatment for opioid use disorder. Methods From January 2019 to February 2020, patients receiving methadone treatment at outpatient opioid treatment programs provided demographics and rated using 1 to 7 Likert-type scales agreement with addiction illness models (brain disease model, chronic medical condition model [CMCM], and no explanation [NEM]) and treatment beliefs. Pairwise comparisons and multivariate regressions were used to examine associations between illness models, demographics, and treatment beliefs. Statistical significance was set at P < 0.05. Results A total of 450 patients participated in the study. Forty percent self-identified as female, 13% as Hispanic, and 78% as White; mean age was 38.5 years. Brain disease model was the most frequently endorsed illness model (46.2%), followed by CMCM (41.7%) and NEM (21.9%). In multivariate analyses, agreement with brain disease model was significantly positively associated with beliefs that methadone treatment would be effective, counseling is important, and methadone is lifesaving, whereas agreement with CMCM was significantly positively associated with beliefs that methadone treatment would be effective, counseling is important, 12-step is the best treatment, taking methadone daily is important, and methadone is lifesaving. In multivariate analyses, agreement with NEM was negatively significantly associated with beliefs that methadone would be effective, counseling is important, taking methadone daily is important, and methadone is lifesaving. Discussion Many patients in methadone treatment endorsed medicalized addiction models. Agreement with addiction illness models appear to be related to treatment beliefs.

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The Future of the United States Overdose Crisis: Challenges and Opportunities

Cited by 4 publications

References 145 publications

Simulating the Simultaneous Impact of Medication for Opioid Use Disorder and Naloxone on Opioid Overdose Death in Eight New York Counties

Simulating the Simultaneous Impact of Medication for Opioid Use Disorder and Naloxone on Opioid Overdose Death in Eight New York Counties

Enhancing drug checking services for supply monitoring: perspectives on implementation in syringe service programs in the USA

A Quantitative Examination of Illness Models Among People With Opioid Use Disorder Receiving Methadone Treatment

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