US drug overdose mortality: 2009–2018 increases affect young people who use drugs

Gaur, Dhruv; Jacka, Brendan; Green, Traci C.; Samuels, Elizabeth A.; Hadland, Scott E.; Krieger, Maxwell S.; Yedinak, Jesse L.; Marshall, Brandon D.L.

doi:10.1016/j.drugpo.2020.102906

Cited by 16 publications

(11 citation statements)

References 16 publications

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“…47 This is a trend also seen nationally, where the highest rates of increase in overdose deaths are among people who are Black. [1][2][3][4] To be able to measure treatment equity, demographic data collected in the EHR need to be complete and accurate. Race or ethnicity data have been found to be missing or inaccurate in 25%-66% of records in large administrative health databases and EHRs.…”

Section: Discussionmentioning

confidence: 99%

“…1 Across the country, the rates of fatal overdoses involving synthetic opioids have increased disproportionately in metropolitan areas, with the highest rates of increase among people who are young, Black, and Latinx. [1][2][3][4] After an emergency department (ED) visit for an opioid overdose, risk of death and repeat overdose are significantly elevated. 5,6 Among an otherwise young and healthy patient population, an overdose-related ED visit may be the only encounter a person with opioid use disorder (OUD) and/or people at risk for opioid overdose have with the healthcare system, and therefore represents a key opportunity to provide patients life-saving harm reduction services and addiction treatment.…”

Section: Introductionmentioning

confidence: 99%

“…The majority of U.S. overdose deaths involve opioids, and over 80% of the 69,710 opioid overdose deaths in 2020 were related to synthetic opioids other than methadone, specifically fentanyl 1 . Across the country, the rates of fatal overdoses involving synthetic opioids have increased disproportionately in metropolitan areas, with the highest rates of increase among people who are young, Black, and Latinx 1–4 …”

Section: Introductionmentioning

confidence: 99%

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Implementation and maintenance of an emergency department naloxone distribution and peer recovery specialist program

Jacka

Ziobrowski

Lawrence

et al. 2021

Academic Emergency Medicine

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Study Objective: Emergency department (ED)-based naloxone distribution and peerbased behavioral counseling have been shown to be feasible, but little is known about utilization maintenance over time and clinician, patient, and visit level factors influencing implementation. Methods: We conducted a retrospective cohort study of an ED overdose prevention program providing take-home naloxone, behavioral counseling, and treatment linkage for patients treated for an opioid overdose at two Rhode Island EDs from 2017 to 2020: one tertiary referral center and a community hospital. Utilizing a Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework, we evaluated program reach, adoption, implementation modifiers, and maintenance using logistic and Poisson regression.Results: Seven hundred forty two patients were discharged after an opioid overdose, comprising 966 visits (median: 32 visits per month; interquartile range: 29, 41). At least one intervention was provided at most (86%, 826/966) visits. Take-home naloxone was provided at 69% of visits (637/919). Over half (51%, 495/966) received behavioral counseling and treatment referral (65%, 609/932). Almost all attending physicians provided take-home naloxone (97%, 105/108), behavioral counseling (95%, 103/108), or treatment referral (95%, 103/108) at least once. Most residents and advanced practice practitioners (APPs) provided take home naloxone (78% residents; 72% APPs), behavioral counseling (76% residents; 67% APPs), and treatment referral (80% residents; 81% APPs) at least once. Most clinicians provided these services for over half of the opioid overdose patients they cared for. Patients were twice as likely to receive behavioral counseling when treated by an attending in combination with a resident and/or APP (adjusted odds ratio: 2.29; 95% confidence interval, 1.68, 3.12) compared to an attending alone. There was no depreciation in use over time.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Implementation and maintenance of an emergency department naloxone distribution and peer recovery specialist program

Jacka

Ziobrowski

Lawrence

et al. 2021

Academic Emergency Medicine

Self Cite

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“…Due to intense governmental and professional efforts that focused on prescription opioids, prescriptions for opioids have decreased, but deaths have increased [30]. Obviously the current approach has been less than successful.…”

Section: Discussionmentioning

confidence: 99%

Commentary: “Ockham’s Razor” Doesn’t Apply to “Opioid” Overdose Death

Peppin¹,

Pergolizzi²,

Vortsman³

et al. 2021

JBM

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Polysubstance Abuse (PSA) greatly complicates an attempt to implicate a single drug as sole cause of an overdose death. Since PSA now occurs in the majority of cases of drug overdoses, many or most overdose deaths are polysubstance overdose deaths. And since many of the substances involved in a polysubstance Overdose Death (POD) are Central Nervous System (CNS) depressants, many of which can cause overdose death themselves, or synergistically with opioids, it is somewhat puzzling that prescription opioids have been singled out as the cause of these deaths-without reference to PSA. This is particularly puzzling in light of the fact that the issues of PSA and POD have been recognized and discussed in the literature since at least the 1960's and before. We therefore here consider the question: are we facing an "opioid" crisis or, instead, a "polysubstance crisis"? And we wonder if the issue has been oversimplified , to the detriment of the individuals affected, and to society more broadly. There is a need for an "agnostic" respiratory stimulant that can reverse polysubstance-induced respiratory depression.

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“…A second challenge that impedes efforts to curb overdose deaths is the rapidly evolving nature of the crisis [20,21]. Sudden, unanticipated shifts in the communities most heavily affected necessitate timely public health surveillance information and the dissemination of information on the shifting landscape of risk to inform effective public health responses [22].…”

Section: Introductionmentioning

confidence: 99%

Preventing Overdose Using Information and Data from the Environment (PROVIDENT): protocol for a randomized, population‐based, community intervention trial

et al. 2021

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Background and Aims In light of the accelerating drug overdose epidemic in North America, new strategies are needed to identify communities most at risk to prioritize geographically the existing public health resources (e.g. street outreach, naloxone distribution efforts). We aimed to develop PROVIDENT (Preventing Overdose using Information and Data from the Environment), a machine learning‐based forecasting tool to predict future overdose deaths at the census block group (i.e. neighbourhood) level. Design Randomized, population‐based, community intervention trial. Setting Rhode Island, USA. Participants All people who reside in Rhode Island during the study period may contribute data to either the model or the trial outcomes. Intervention Each of the state's 39 municipalities will be randomized to the intervention (PROVIDENT) or comparator condition. An interactive, web‐based tool will be developed to visualize the PROVIDENT model predictions. Municipalities assigned to the treatment arm will receive neighbourhood risk predictions from the PROVIDENT model, and state agencies and community‐based organizations will direct resources to neighbourhoods identified as high risk. Municipalities assigned to the control arm will continue to receive surveillance information and overdose prevention resources, but they will not receive neighbourhood risk predictions. Measurements The primary outcome is the municipal‐level rate of fatal and non‐fatal drug overdoses. Fatal overdoses will be defined as unintentional drug‐related death; non‐fatal overdoses will be defined as an emergency department visit for a suspected overdose reported through the state's syndromic surveillance system. Intervention efficacy will be assessed using Poisson or negative binomial regression to estimate incidence rate ratios comparing fatal and non‐fatal overdose rates in treatment vs. control municipalities. Comments The findings will inform the utility of predictive modelling as a tool to improve public health decision‐making and inform resource allocation to communities that should be prioritized for prevention, treatment, recovery and overdose rescue services.

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US drug overdose mortality: 2009–2018 increases affect young people who use drugs

Cited by 16 publications

References 16 publications

Implementation and maintenance of an emergency department naloxone distribution and peer recovery specialist program

Implementation and maintenance of an emergency department naloxone distribution and peer recovery specialist program

Commentary: “Ockham’s Razor” Doesn’t Apply to “Opioid” Overdose Death

Preventing Overdose Using Information and Data from the Environment (PROVIDENT): protocol for a randomized, population‐based, community intervention trial

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