The Opioid Hydra: Understanding Overdose Mortality Epidemics and Syndemics Across the Rural‐Urban Continuum

Peters, David J.; Monnat, Shannon M.; Hochstetler, Andrew; Berg, Mark T.

doi:10.1111/ruso.12307

Cited by 80 publications

(89 citation statements)

References 55 publications

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“…The income inequality-health literature and the aforementioned studies by Monnat (2018Monnat ( , 2019 and Peters et al (2019) also highlight that different parts of the income distribution may affect drugrelated mortality more so than others. The inequalityhealth literature has generally focused on inequality measures that quantify the concentration of income at the top of the distribution or the Gini coefficient that takes into account the entire distribution while giving less attention to the bottom of the income distribution (Hill and Jorgenson 2018;Pickett and Wilkinson 2015;Wilkinson and Pickett 2010).…”

Section: Divergent Perspectives On the Drivers Of The Drug Overdose Ementioning

confidence: 99%

“…Monnat (2019), although not explicitly investigating inequality, found that more economically distressed counties have higher drug-related mortality rates. Peters et al (2019), whom also did not investigate inequality explicitly, found that places hit hardest by the prescription-opioid epidemic are those that have been economically left behind. These studies illustrate that economic distress plays a significant role in the drug epidemic and that supply-side factors also matter, but they only tangentially linked their findings to the unequal distribution of resources and power in society.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

What Is Driving the Drug Overdose Epidemic in the United States?

Thombs

Jorgenson

et al. 2020

J Health Soc Behav

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The demand-side perspective argues that the drug overdose epidemic is a consequence of changes in the economy that leave behind working-class people who lack a college education. In contrast, the supply-side perspective maintains that the epidemic is primarily due to changes in the licit and illicit drug environment, whereas a third, distinct perspective argues that income inequality is likely a key driver of the epidemic. To evaluate these competing perspectives, we use a two-level random intercept model and U.S. state-level data from 2006 to 2017. Contrary to the demand-side approach, we find that educational attainment is not associated with drug-related mortality. In support of the supply-side approach, we provide evidence indicating that opioid prescription rates are positively associated with drug-related mortality. We also find that income inequality is a key driver of the epidemic, particularly the lack of resources going to the bottom 20% of earners. We conclude by arguing that considerations of income inequality are an important way to link the arguments made by the demand-side and the supply-side perspectives.

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Section: Divergent Perspectives On the Drivers Of The Drug Overdose Ementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

What Is Driving the Drug Overdose Epidemic in the United States?

Thombs

Jorgenson

et al. 2020

J Health Soc Behav

View full text Add to dashboard Cite

show abstract

“…In recent years, there has been a shift in several western countries towards an increasing number of opioid deaths Fig. 2 Opioid-related deaths in Skåne grouped by the substances that caused the intoxication, by period in less densely populated communities outside metropolitan areas [48][49][50]. In this study, the three larger municipalities in Skåne were the places in which access to OST had increased the most and no increase in the proportion of deaths was noted in these.…”

Section: Discussionmentioning

confidence: 83%

Changes in opioid-related deaths following increased access to opioid substitution treatment

Andersson

Håkansson

Berge

et al. 2021

Subst Abuse Treat Prev Policy

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Background Opioid-related mortality is high and increasing in the Western world, and interventions aimed at reducing opioid-related deaths represent an important area of study. In Skåne County, Sweden, a patient choice reform resulted in increased access to opioid substitution treatment (OST). In addition, a gradual shift towards less restrictive terms for exclusion from OST has been implemented. The aim of this study was to assess the impact of these policy changes on opioid-related deaths. Methods Detailed data on opioid-related deaths in Skåne during the 2 years prior to and following the policy change were obtained from forensic records and from health care services. Data on overdose deaths for Skåne and the rest of Sweden were obtained using publicly available national register data. Time periods were used as the predictor for opioid-related deaths in the forensic data. The national level data were used in a natural experiment design in which rates of overdose deaths were compared between Skåne and the rest of Sweden before and after the intervention. Results There was no significant difference in the number of deaths in Skåne between the data collection periods (RR: 1.18 95% CI:0.89–1.57, p= 0.251). The proportion of deaths among patients enrolled in OST increased between the two periods (2.61, 1.12–6.10, p= 0.026). There was no change in deaths related to methadone or buprenorphine in relation to deaths due to the other opioids included in the study (0.92, 0.51–1.63, p= 0.764). An analysis of national mortality data showed an annual relative decrease in unintentional drug deaths in Skåne compared to the rest of Sweden following the onset of the reform (0.90, 0.84–0,97, p= 0.004). Conclusions Opioid-related deaths, as assessed using forensic data, has not changed significantly in Skåne following a change to lower-threshold OST. By contrast, national level data indicate that the policy change has been associated with decreased overdose deaths. The discrepancy between these results highlights the need for more research to elucidate this issue. The result that more patients die during ongoing OST following an increase in access to treatment underlines the need for further preventive interventions within the OST treatment setting.

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“…A previous evaluation has shown proximity to the clinic to be important for patients in OST when choosing a treatment facility [19]. In recent years, there has been a shift in several western countries towards an increasing number of opioid deaths in less densely populated communities outside metropolitan areas [47,48,49]. In this study, the three larger municipalities in Skåne were the places in which access to OST had increased the most and no increase in the proportion of deaths was noted in these.…”

Section: Discussionmentioning

confidence: 99%

Changes in opioid mortality following increased access to opioid substitution treatment

Andersson¹,

Håkansson²,

Berge³

et al. 2020

Preprint

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Background Opioid-related mortality is high and increasing in the Western world, and interventions aimed at reducing mortality represent an important area of study. In Skåne County, Sweden, a patient choice reform resulted in increased access to opioid substitution treatment (OST). In addition, a gradual shift towards less restrictive terms for exclusion from OST has been implemented. The aim of this study was to assess the impact of these policy changes on opioid-related mortality. Methods Detailed data on all opioid-induced deaths in Skåne during the two years prior to and following the policy change were obtained from forensic records and from health care services. Data on overdose deaths for Skåne and the rest of Sweden were obtained using publicly available national register data. Time periods were used as the predictor for opioid-related mortalities in the forensic data. The national level data were used in a natural experiment design in which rates of overdose deaths were compared between Skåne and the rest of Sweden before and after the intervention.Results There was a non-significant increase in the number of deaths in Skåne between the data collection periods (RR: 1.18 95% CI:0.89-1.57, p= 0.251). The proportion of deaths among patients enrolled in OST increased between the two periods (2.61, 1.12-6.10, p= 0.026). There was no change in deaths related to methadone or buprenorphine in relation to deaths due to the other opioids included in the study (0.92, 0.51-1.63, p= 0.764). An analysis of national mortality data showed an annual relative decrease in unintentional drug intoxications in Skåne compared to the rest of Sweden following the onset of the reform (0.90, 0.84-0,97, p= 0.004). Conclusions Opioid-related mortality, as assessed using forensic data, has not changed significantly in Skåne following a change to lower-threshold OST. By contrast, national level data indicate that the policy change has been associated with decreased opioid mortality. The discrepancy between these results highlights the need for more research to elucidate this issue. The result that more patients die during ongoing OST following an increase in access to treatment underlines the need for further preventive interventions within the OST treatment setting.

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The Opioid Hydra: Understanding Overdose Mortality Epidemics and Syndemics Across the Rural‐Urban Continuum

Cited by 80 publications

References 55 publications

What Is Driving the Drug Overdose Epidemic in the United States?

What Is Driving the Drug Overdose Epidemic in the United States?

Changes in opioid-related deaths following increased access to opioid substitution treatment

Changes in opioid mortality following increased access to opioid substitution treatment

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