Drug Overdose Deaths Research Articles

Abstract Su1107: Online educational film depiction of opioid overdose causing cardiac arrest

Introduction: Opioid overdose (OD) is a growing cause of cardiac arrest in the US, spurred by the rise of illegally manufactured fentanyl and analogs. Naloxone is a reversal agent that can be administered by bystanders. Intra-nasal (IN) naloxone is now widely available in pharmacies across the US. Despite increasing access, minority populations remain disproportionately affected by drug overdose deaths. There are many free online opioid OD educational videos. Digital media can be a powerful tool for mass education, but the effectiveness is unknown. Research Question and Aims: The goal of this study was to evaluate online opioid overdose videos for content and gender/racial representation. Methods: We performed an online search with the query “how to give Narcan” (popular term for IN naloxone). Results were limited to the first 52 Google, 50 YouTube, and 60 TikTok videos. Exclusion criteria included: animal victim, duplicate, or no mention of naloxone. For each video, 2 reviewers evaluated content and identified the race and gender of featured characters. Disagreements were resolved through consensus. The race and gender of featured characters was compared using a two proportion z-test. Inter-rater reliability (IRR) for each data point was calculated using the arithmetic mean of Cohen's kappa. Results: Of 121 videos, the majority (87.6%) mentioned naloxone as a treatment for opioid OD; 62.8% provided instruction on how to administer IN naloxone, and 4.1% featured a testimonial. Only 43.0% provided a realistic visual demonstration of IN naloxone administration; 25.6% showed a realistic re-enactment of opioid overdose, and even fewer (19.0%) showed the dramatic response to naloxone. IRR was high for all categories. Videos predominantly featured white compared to non-white-appearing characters in both the victim (75.5 v. 17.8%, p< 0.00001) and rescuer roles (72.5 v 21.6%, p<0.00001). The rescuer gender was evenly distributed male v. female; however, the victim was more often male (77.8% v. 22.2%, p<0.00001). Conclusion: Most online opioid OD videos provide instructions on how to use IN naloxone, but do not feature realistic depictions of cardiac arrest caused by opioid OD, naloxone treatment, or response. There is a significant lack of racial diversity in these videos. Digital materials are needed with improved diversity and which teach learners how to RECOGNIZE and respond to opioid OD.

Notes from the Field: Ketamine Detection and Involvement in Drug Overdose Deaths - United States, July 2019-June 2023.

Notes from the Field: Ketamine Detection and Involvement in Drug Overdose Deaths - United States, July 2019-June 2023.

Temporal and spatial trends of fentanyl co-occurrence in the illicit drug supply in the United States: a serial cross-sectional analysis

BackgroundFentanyl and its analogs contribute substantially to drug overdose deaths in the United States. There is concern that people using drugs are being unknowingly exposed to fentanyl, increasing their risk of overdose death. This study examines temporal trends and spatial variations in the co-occurrence of fentanyl with other seized drugs. MethodsWe identified fentanyl co-occurrence (the proportion of samples of non-fentanyl substances that also contain fentanyl) among 9 substances or substance classes of interest: methamphetamine, cannabis, cocaine, heroin, club drugs, hallucinogens, and prescription opioids, stimulants, and benzodiazepines. We used serial cross-sectional data on drug reports across 50 states and the District of Columbia from the National Forensic Laboratory Information System, the largest available database on the U.S. illicit drug supply, from January 2013 to December 2023. FindingsWe analyzed data from 11,940,207 samples. Fentanyl co-occurrence with all examined substances increased monotonically over time (Mann-Kendall p<0.0001). Nationally, fentanyl co-occurrence was highest among heroin samples (approx. 50%), but relatively low among methamphetamine (≤1%), cocaine (≤4%), and other drug samples. However, co-occurrence rates have grown to over 10% for cocaine and methamphetamine in several Northeast states in 2017-2023. InterpretationFentanyl co-occurs most commonly with heroin, but its presence in stimulant supplies is increasing in some areas, where it may pose a disproportionately high risk of overdose. FundingThis work was partly supported by FDA grant U01FD00745501. This article reflects the views of the authors and does not represent the views or policies of the FDA or US Department of Health and Human Services.

A Holistic Harm Reduction Center Model: A Commentary

Substance addiction is a chronic, relapsing disorder characterized by compulsive drug seeking, loss of control over consumption, and a negative emotional state when access to the drug is restricted. Substance Use Disorders (SUDs) are associated with severe health issues including suicide and co-occurring diseases like HIV and hepatitis C, and mental health problems. Although the present SUD treatment models prioritize abstinence, achieving abstinence during a treatment episode is challenging as majority of individuals with SUDs continue using drugs during treatment. To address this challenge in the current SUD treatment model, harm reduction has emerged as a strategy that focuses on interventions such as naloxone distribution, syringe services, safe drug use education and other strategies that reduce harmful outcomes such as substance-related overdose death and disease transmission while improving quality of life. This commentary proposes a Holistic Harm Reduction Model that can be incorporated by harm reduction centers aimed at reducing risky drug use behavior and overdose deaths, and ultimately improving public health outcomes in the community. The proposed holistic model includes new components such as trauma-informed care and referral and a brief mindfulness intervention along with the already existing harm reduction approaches such as Licensed Practical Nurses (LPNs) and harm reduction managers to provide comprehensive healthcare services, distribution of supplies; education; referral and linkage to other services, including medications for substance use disorder; and participant data collection and analysis.

Detection of Hepatovirus A (HAV) in wastewater indicates widespread national distribution and association with socioeconomic indicators of vulnerability.

Wastewater-based epidemiology, which seeks to assess disease occurrence in communities through measurements of infectious disease biomarkers in wastewater, may represent a valuable tool for understanding the occurrence of hepatitis A infections in communities. In this study, we measured concentrations of Hepatovirus A (HAV) RNA, in samples from 191 wastewater treatment plants spanning 40 US states and the District of Columbia from September 2023 to June 2024 and compared the measurements with traditional measures of disease occurrence. Nationally, 13.76% of the 21,079 wastewater samples were positive for HAV RNA, and both concentrations and positivity rates were associated with NNDSS hepatitis A case data nationally (Kendall rank correlation coefficient = 0.20, concentrations; and 0.33, positivity rate; both P < 0.05). We further demonstrated that higher rates of wastewater HAV detection were positively associated with socioeconomic indicators of vulnerability including homelessness and drug overdose deaths (both P < 0.0001). Areas with above average levels of homelessness were 48% more likely to have HAV wastewater detections, while areas with above average levels of drug overdose deaths were 14% more likely to have HAV wastewater detections. Using more granular case data, we present a case study in the state of Maine that reinforces these results and suggests a potential lead time for wastewater over clinical case detection and exposure events. The ability to detect HAV RNA in wastewater before clinical cases emerge could allow public health officials to implement targeted interventions like vaccination campaigns.IMPORTANCEDespite the existence of a highly effective vaccine for hepatitis A, outbreaks in vulnerable populations remain common. The disease can be asymptomatic or subclinical, and disproportionately impacts populations with inadequate access to healthcare, leading to a severe underestimation of the occurrence of this viral infection. This study investigates the potential for wastewater measurements of biomarkers of the causative agent of hepatitis A (HAV RNA) to provide insights into disease occurrence. Results highlight the potential for wastewater-based epidemiology to be a complementary tool to traditional surveillance for monitoring and controlling HAV transmission.

Unpacking the Effects of Decriminalization: Understanding Drug Use Experiences and Risks among Individuals Who Use Drugs in British Columbia

ObjectivesOn January 31, 2023, a three-year exemption from the Controlled Drugs and Substances Act was granted to the Canadian province British Columbia (BC), allowing the cumulative possession of 2.5 g of specific unregulated drugs amongst adults. The goals of the policy are to reduce health, social, and economic harms associated with criminalization, stigma, drug overdose deaths, as well as drug seizures, arrests, and associated enforcement and court costs. As the inaugural year has passed, we aimed to assess people who use drugs’ awareness and knowledge of the, as well as the policy’s impact on their drug use patterns and overdose risk.MethodsWe conducted 100 telephone-based semi-structured interviews with people who use drugs from across BC, exploring changes in drug use experiences and perceived overdose risk since the implementation of the policy. Participants also completed an interviewer-administered survey assessing socio-demographics and substance use patterns. We utilized a qualitative content analysis approach to analyze the interview data.ResultsOur findings indicate a general awareness of the policy among participants, although some policy details were often misunderstood, and participants expressed the need for more widespread dissemination of policy information. While the majority of participants reported that their drug use patterns remained unchanged after decriminalization, some made subtle adjustments, such as carrying under the 2.5 g threshold to minimize the risk of criminalization. Participants highlighted several policy benefits and concerns, including its potential to reduce criminalization and stigmatization, but also increase public drug consumption. Participants offered suggestions for policy improvement.ConclusionThese findings underscore the need for ongoing monitoring of the impacts of decriminalization regarding its potential impact on people who use drugs’ drug use patterns and related risks. Reevaluation of the possession threshold and efforts to enhance education and awareness about the policy could help achieve the policy’s goals.

Communities That HEAL Intervention and Mortality Including Polysubstance Overdose Deaths

The HEALing Communities Study (HCS) evaluated the effectiveness of the Communities That HEAL (CTH) intervention in preventing fatal overdoses amidst the US opioid epidemic. To evaluate the impact of the CTH intervention on total drug overdose deaths and overdose deaths involving combinations of opioids with psychostimulants or benzodiazepines. This randomized clinical trial was a parallel-arm, multisite, community-randomized, open, and waitlisted controlled comparison trial of communities in 4 US states between 2020 and 2023. Eligible communities were those reporting high opioid overdose fatality rates in Kentucky, Massachusetts, New York, and Ohio. Covariate constrained randomization stratified by state allocated communities to the intervention or control group. Trial groups were balanced by urban or rural classification, 2016-2017 fatal opioid overdose rate, and community population. Data analysis was completed by December 2023. Increased overdose education and naloxone distribution, treatment with medications for opioid use disorder, safer opioid prescribing practices, and communication campaigns to mitigate stigma and drive demand for evidence-based interventions. The primary outcome was the number of drug overdose deaths among adults (aged 18 years or older), with secondary outcomes of overdose deaths involving specific opioid-involved drug combinations from death certificates. Rates of overdose deaths per 100 000 adult community residents in intervention and control communities from July 2021 to June 2022 were compared with analyses performed in 2023. In 67 participating communities (34 in the intervention group, 33 in the control group) and including 8 211 506 participants (4 251 903 female [51.8%]; 1 273 394 Black [15.5%], 603 983 Hispanic [7.4%], 5 979 602 White [72.8%], 354 527 other [4.3%]), the average rate of overdose deaths involving all substances was 57.6 per 100 000 population in the intervention group and 61.2 per 100 000 population in the control group. This was not a statistically significant difference (adjusted rate ratio [aRR], 0.92; 95% CI, 0.78-1.07; P = .26). There was a statistically significant 37% reduction (aRR, 0.63; 95% CI, 0.44-0.91; P = .02) in death rates involving an opioid and psychostimulants (other than cocaine), and nonsignificant reductions in overdose deaths for an opioid with cocaine (6%) and an opioid with benzodiazepine (1%). In this clinical trial of the CTH intervention, death rates involving an opioid and noncocaine psychostimulant were reduced; total deaths did not differ statistically. Community-focused data-driven interventions that scale up evidence-based practices with communications campaigns may effectively reduce some opioid-involved polysubstance overdose deaths. ClinicalTrials.gov Identifier: NCT04111939.

Drug overdose deaths among homeless veterans in the United States Department of Veterans Affairs healthcare system.

With an epidemic of drug overdoses, contemporary research is needed to examine drug overdose deaths among homeless populations. This study measured rates, types and correlates of drug overdose deaths occurring over a 5-year study period among veterans experiencing homelessness (VEH) and non-homeless veterans (NHV) in the US Department of Veterans Affairs (VA) healthcare system. Retrospective cohort study. USA. A total of 6 128 921 veterans. We followed 399 125 VEH and 5 729 796 NHV between 2017 and 2021 using linked administrative VA and National Death Index data. Multivariable Cox regression models were constructed to estimate hazard ratios (HRs) for homelessness as a predictor of time-to-occurrence of overdose deaths with 95% confidence interval (CIs), sequentially controlling for demographic, medical, substance use and mental health characteristics. Among overdose deaths, 8653 [93.7%, 95% confidence interval (CI) = 93.2-94.2%] were unintentional and 5378 (57.8%, 95% CI = 56.8-58.8%) involved opioids. The overdose-specific mortality rate (per 100 000 person-years) was 227.3 among VEH and 23.2 among NHV (HR = 9.76, 95% CI = 9.36, 10.16), with rates 7-14 times higher among VEH than NHV, depending on the drug involved. In fully adjusted models, homelessness was associated with greater risk of drug overdose death (HR = 3.33, 95% CI = 3.18, 3.49), with the greatest risk involving psychostimulants (HR = 4.19), followed by antiepileptic/sedative/hypnotic drugs (HR = 3.69), synthetic opioids (HR = 3.50) and natural and semi-synthetic opioids (HR = 2.79). US veterans experiencing homelessness appear to have three times the risk for drug overdose deaths than non-homeless veterans. There may be specific risks associated with psychostimulant, antiepileptic, sedative and hypnotic drugs in this population that deserve greater attention.

Investigating the Interrelationship between the Desire for a Cohesive Community and Opioid Abuse: A Neuropsychological Study of Demon Copperhead

Abstract Foregrounding the increasing global crisis of opioids as the “leading cause of deaths in fatal overdoses,” the World Drug Report 2023, published by the United Nations Office on Drugs and Crime (UNODC), mentioned that in 2021 more than 80,000 people died due to opioid overdose in the United States of America. The Centers for Disease Control and Prevention (CDC), the national public health protection agency in the United States, has reported that “the predicted number of drug overdose deaths showed an increase of 0.5% from the 12 months ending in December 2021 to the 12 months ending in December 2022, from 109,179 to 179,680” (“Provisional Data”). Although the trajectory of opioid use disorders (OUDs) has affected different sociodemographic groups in the country since its first wave in the 1990s, teenagers in poverty-stricken rural areas are more vulnerable to such addiction (Keyes et al.). Poor parental guidance, impoverishment, troubled childhoods, detrimental familial structure, scarce opportunities, and accessibility to opioids are often considered to be the primary risk factors for unprivileged teenagers to develop a psychic reliance on opioids for engendering a perpetual sense of contentment. According to the incentive sensitization theory, the persistent desire to transcend physical and psychical limitations for a sense of relief, triggered by chronic drug misuse, often evokes a sense of “wanting” or incentive salience, a compulsive inclination towards drug-associated stimuli (Berridge and Robinson, “Drug Addiction” 22). This intense desire of “wanting” often generates a perpetual sensitization of the mesolimbic systems in the brain which is also activated by mental representations of drug-associated cues (Robinson and Berridge 3139). Focusing on drug-induced changes in the brain such as hypersensitization and neuroadaptation, this study analyzes Barbara Kingsolver’s Demon Copperhead, a modern reimagining of David Copperfield by Charles Dickens. The selected text addresses primarily some pertinent socio-political crises, such as the poor foster care system, poverty, and the engrossing opioid endemic in Southern Appalachia. However, this study attempts to analyze the precarious state of some characters, who become addicted to opioids seeking recognition from peer groups and perpetual psychic stability, in the selected text from a neuropsychological perspective.

Prescribers' perspectives: The impact of the controlled substance scheduling system on providing optimal patient care

BackgroundIn the United States, the scheduling system for controlled substances was established by the Controlled Substance Act of 1970. In 2009, Parker et al. published the study “Physicians' knowledge and attitudes toward scheduling.” Since 2009, the opioid epidemic has gathered national attention from social and scientific perspectives as the number of drug overdose deaths in the United States has nearly tripled. ObjectiveTo follow up on a 2009 survey by Parker, et al. to determine prescribers' knowledge and attitudes regarding the controlled substance scheduling system and assess the impact of the controlled substance scheduling system on providing optimal patient care. MethodsThe cross-sectional survey was designed to assess prescribers' attitudes and mailed to 400 randomly selected physicians and 400 randomly selected nurse practitioners. ResultsPrescribers across all groups provided consistent responses suggesting an overall lack of understanding of controlled substance regulations, a negative attitude towards the controlled substance scheduling system, and a detrimental effect on providing optimal patient care. Responses from nurse practitioners differed significantly from physicians in 75 % (3 of the 4) questions regarding regulations, suggesting nurse practitioners possess a greater understanding of pharmaceutical regulations. Specialists' responses demonstrated an enhanced level of dissatisfaction regarding the controlled substance scheduling system compared to primary care providers in 75 % (3 of the 4) questions. Questions regarding the impact of the scheduling system on prescribing patterns differed significantly across multiple demographic groups, notably between physicians and nurse practitioners, differences in practice setting, and primary state of practice for 75 % (3 of the 4) questions. ConclusionsThe results of this survey confirm the findings of Parker, et al., and further display the need for investigation into how to improve the controlled substance scheduling system in the United States.

Medicaid Expansion and Mortality Among Persons Who Were Formerly Incarcerated

Since 2014, Medicaid expansion has been implemented in many states across the US, increasing health care access among vulnerable populations, including formerly incarcerated people who experience higher mortality rates than the general population. To examine population-level association of Medicaid expansion with postrelease mortality from all causes, unintentional drug overdoses, opioid overdoses, polydrug overdoses, suicides, and homicides among formerly incarcerated people in Rhode Island (RI), which expanded Medicaid, compared with North Carolina (NC), which did not expand Medicaid during the study period. A cohort study was conducted using incarceration release data from January 1, 2009, to December 31, 2018, linked to death records from January 1, 2009, to December 31, 2019, on individuals released from incarceration in RI and NC. Data analysis was performed from August 20, 2022, to February 15, 2024. Participants included those aged 18 years or older who were released from incarceration. Individuals who were temporarily held during ongoing judicial proceedings, died during incarceration, or not released from incarceration during the study period were excluded. Full Medicaid expansion in RI effective January 1, 2014. Mortality from all causes, unintentional drug overdoses, unintentional opioid and polydrug overdoses, suicides, and homicides. Between 2009 and 2018, 17 824 individuals were released from RI prisons (mean [SD] age, 38.39 [10.85] years; 31 512 [89.1%] male) and 160 861 were released from NC prisons (mean [SD] age, 38.28 [10.84] years; 209 021 [87.5%] male). Compared with NC, people who were formerly incarcerated in RI experienced a sustained decrease of 72 per 100 000 person-years (95% CI, -108 to -36 per 100 000 person-years) in all-cause mortality per quarter after Medicaid expansion. Similar decreases were observed in RI in drug overdose deaths (-172 per 100 000 person-years per 6 months; 95% CI, -226 to -117 per 100 000 person-years), including opioid and polydrug overdoses, and homicide deaths (-23 per 100 000 person-years per year; 95% CI, -50 to 4 per 100 000 person-years) after Medicaid expansion. Suicide mortality did not change after Medicaid expansion. After Medicaid expansion in RI, non-Hispanic White individuals experienced 3 times greater sustained decreases in all-cause mortality than all racially minoritized individuals combined, while non-Hispanic Black individuals did not experience any substantial benefits. There was no modification by sex. Individuals aged 30 years or older experienced greater all-cause mortality reduction after Medicaid expansion than those younger than 30 years. Medicaid expansion in RI was associated with a decrease in all-cause, overdose, and homicide mortality among formerly incarcerated people. However, these decreases were most observed among White individuals, while racially minoritized individuals received little to no benefits in the studied outcomes.

Correlates of fentanyl preference among people who use drugs in Rhode Island

BackgroundFentanyl is increasingly pervasive in the unregulated drug supply and is a driver of drug overdose deaths in the United States. The aims of this study were to characterize and identify correlates of fentanyl preference among people who use drugs (PWUD) in Rhode Island (RI).MethodsUsing bivariate analysis, we examined associations between fentanyl preference and sociodemographic and psychosocial characteristics at baseline among participants enrolled in the RI Prescription Drug and Illicit Drug Study from August 2020-February 2023. Fentanyl preference was operationalized based on responses to a five-point Likert scale: “I prefer using fentanyl or drugs that have fentanyl in them.” Participants who responded that they “strongly disagree,” “disagree,” or were “neutral” with respect to this statement were classified as not preferring fentanyl, whereas participants who responded that they “agree” or “strongly agree” were classified as preferring fentanyl.ResultsAmong 506 PWUD eligible for inclusion in this analysis, 15% expressed a preference for fentanyl or drugs containing fentanyl as their drug of choice. In bivariate analyses, preference for fentanyl was positively associated with younger age, white race, lifetime history of overdose, history of injection drug use, past month enrollment in a substance use treatment program, past month treatment with medications for opioid use disorder, and preferences for heroin and crystal methamphetamine (all p < 0.05). Descriptive data yielded further insight into reasons for fentanyl preference, the predominant having to do with perceived effects of the drug and desire to avoid withdrawal symptoms.ConclusionsOnly a relatively small subset of study participants preferred drugs containing fentanyl. Given the increased prevalence of fentanyl contamination across substances within the unregulated drug market, the result for PWUD is increasingly less agency with respect to choice of drug; for example, people may be forced to use fentanyl due to restricted supply and the need to mitigate withdrawal symptoms, or may be using fentanyl without intending to do so. Novel and more effective interventions for PWUD, including increased access to age-appropriate harm reduction programs such as fentanyl test strips and overdose prevention centers, are needed to mitigate fentanyl-related harms.

Overdose Detection Among High-Risk Opioid Users Via a Wearable Chest Sensor in a Supervised Injecting Facility: Protocol for an Observational Study.

Opioid overdose is a global health crisis, affecting over 27 million individuals worldwide, with more than 100,000 drug overdose deaths in the United States in 2022-2023. This protocol outlines the development of the PneumoWave chest biosensor, a wearable device being designed to detect respiratory depression in real time through chest motion measurement, intending to enhance early intervention and thereby reduce fatalities. The study aims to (1) differentiate opioid-induced respiratory depression (OIRD) from nonfatal opioid use patterns to develop and refine an overdose detection algorithm and (2) examine participants' acceptability of the chest biosensor. The study adopts an observational design over a 6-month period. The biosensor, a small device, will be worn by consenting participants during injecting events to capture chest motion data. Safe injecting facilities (SIF) in Melbourne, Victoria (site 1), and Sydney, New South Wales (site 2), which are legally sanctioned spaces where individuals can use preobtained illicit drugs under medical supervision. Each site is anticipated to recruit up to 100 participants who inject opioids and attend the SIF. Participants will wear the biosensor during supervised injecting events at both sites. The biosensor will attempt to capture data on an anticipated 40 adverse drug events. The biosensor's ability to detect OIRD will be compared to the staff-identified events that use standard protocols for managing overdoses. Measurements will include (1) chest wall movement measured by the biosensor, securely streamed to a cloud, and analyzed to refine an overdose detection algorithm and (2) acute events or potential overdose identified by site staff. Acceptability will be measured by a feedback questionnaire as many times as the participant is willing to throughout the study. As of April 2024, a total of 47 participants have been enrolled and data from 1145 injecting events have already been collected, including 10 overdose events. This consists of 17 females and 30 males with an average age of 45 years. Data analysis is ongoing. This protocol establishes a foundation for advancing wearable technology in opioid overdose prevention within SIFs. The study will provide chest wall movement data and associated overdose data that will be used to train an algorithm that allows the biosensor to detect an overdose. The study will contribute crucial insights into OIRD, emphasizing the biosensor's potential step forward in real-time intervention strategies. DERR1-10.2196/57367.

Modeling Changes of Fatal Xylazine-Involved Drug Overdoses in Connecticut Across Time

Background Fatal drug overdoses have involved both xylazine and fentanyl. Xylazine is a non-opioid substance used in veterinary medicine. This study aimed to model changes in fatal xylazine-involved drug overdose deaths from 2019 to 2023 in Connecticut using overdose death data from the Office of the Chief Medical Examiner. Methods Xylazine-involved drug overdose fatality rates were calculated by number of deaths per year per 100,000 population from 2019 to 2023. We used joinpoint regression modeling to evaluate quarterly overdose rates across age, number of drugs, and drug types with a significance level of p < 0.05. Results From 2019 to 2023, there were 1116 xylazine-involved fatal overdoses with a cumulative rate of 31.3 deaths per 100,000. Xylazine-involved overdose death rates were significantly higher in Hispanic populations compared to both non-Hispanic White and Black populations (p < 0.05). The joinpoint analyses showed that xylazine-fentanyl mortality rates significantly increased by 0.18 per 100,000 per quarter from 2019 to 2022. Xylazine-fentanyl overdoses involving at least 4 or 5 substances significantly increased. Windham, Hartford, New London, and New Haven counties had the highest xylazine-involved death rates. Conclusion Xylazine-fentanyl deaths increased from 2019 to 2023, and often involved multiple substances (e.g., cocaine, ethanol, benzodiazepines, and oxycodone). Results show Hispanic populations, those aged 35–49, and 50+ experienced high rates of xylazine-fentanyl overdose deaths. Vulnerable populations in Connecticut for special consideration for future intervention and local resource allocation are recommended.

Harnessing Machine Learning to Predict Methadone Overdose Risk: Insights from Illinois's SUDORS Data

Knowledge of decedent characteristics associated with methadone involvement in unintentional drug overdose deaths can help to inform efforts to intervene in these deaths. ML models with existing data, offer a cost-effective means to help create effective interventions. In this study, we aim to develop an optimized ML algorithm for predicting overdose death patterns due to methadone using data from Illinois's State Unintentional Drug Overdose Reporting System (SUDORS). We utilized IL SUDORS 2019-2022 data for training (n = 11931) with selected indicators (n = 28). To address the imbalance in non-methadone-related deaths, we applied the Synthetic Minority Oversampling Technique. Next, we assessed various machine learning models, including logistic regression, support vector machine, random forest, neural network, and ridge regression. Model performance was evaluated using metrics such as accuracy, precision, area under the precision-recall curve (AUPRC), etc. Utilizing separate training (n = 15813), validation (n = 3388), and test (n = 3389) datasets, the Random Forest Model outperforms all other models with 92% accuracy, 91% precision, 93% recall, and 0.97 AUPRC. Notably, these outcomes were achieved using primarily demographic indicators. Through analyzing partial dependence plots, we were able to see how changes in each indicator dynamically influence methadone-related fatalities. This study demonstrates the potential of ML models in identification of methadone involvement in unintentional drug overdose deaths and contributes to the knowledge base for the prevention of these deaths. Leveraging SUDORS data, the Random Forest Model exhibited exceptional performance, highlighting its value for healthcare professionals, prevention and harm reduction specialists, and policymakers.

"Everyone blames you": Stigma and caregiver burden among parents of children with substance use disorder.

Recent increases in drug overdose deaths have created a significant public health crisis in the United States. Individuals diagnosed with substance use disorder (SUD) often rely on their social support network as they engage in treatment and recovery. While support from parents, in particular, can be vital in recovery, stress associated with supporting loved ones with SUD can have detrimental effects on health and well-being. Stigma toward parents and loved ones further complicates the support they can offer. The present study explores caregiver burden and stigma experienced by parents of children with SUD. The impact of these experiences on their ability to access support and resources, both for themselves and their children, is of particular interest. In-depth one-on-one interviews were conducted with 25 parents (92% mothers) of children (ages 17-32 years old) with SUD. Qualitative thematic analysis resulted in three themes: (1) caregiving and associated burden, (2) parent experiences with SUD stigma, and (3) impact of stigma on caregiver support. Experiences of burden and stigma were prevalent; parents reported stigma directed at them due to their child's diagnosis (associative stigma) as well as psychological distress they experienced witnessing their children experience stigma (vicarious stigma). Fear of judgment and shame led parents to avoid disclosing their child's SUD to others and impeded help-seeking behavior. When parents did seek formal help, resources were limited and insufficient. The findings underscore the need for increased understanding and acceptance from the community, emphasizing the potential role of education in reshaping perceptions. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

United States opioid prescribing trends after shoulder surgery and their correlation with opioid misuse

BACKGROUNDOrthopedic surgery has been highlighted as a contributor to the opioid epidemic. There is a paucity of literature focused specifically on opioid prescribing trends following shoulder surgery. Our aims were to describe national and regional trends in opioid prescribing following total shoulder arthroplasty (TSA), proximal humerus fracture fixation, and rotator cuff repair (RCR), and to correlate opioid prescribing trends after shoulder surgery with regional heroin use and new opioid misuse diagnoses. METHODSThis is a retrospective study of 218,577 patients from a commercial insurance dataset who had undergone orthopedic shoulder procedures from 2014-2020. Opioid prescription data within 90-day postop were converted to morphine milligram equivalents (MME). Multivariate modelling was used to evaluate independent associations between MME’s prescribed and subsequent new postoperative diagnosis of opioid dependence. Additionally, longitudinal mixed effects modeling was employed to understand aggregated prescriber habits by state over time and the subsequent effects on estimates of state heroin use and drug overdose deaths. RESULTSFrom 2014 to 2020, the mean number of MMEs prescribed nationally decreased by over 50% for TSA, proximal humerus fracture fixation, and RCR. Over the study period, most states demonstrated an overall downtrend of 90-day opioid prescribing for these procedures.Individuals with a new opioid misuse diagnosis following shoulder surgery were found to be younger (SMD=0.27, p<0.001), have increased comorbidities (SMD=0.38, p<0.001), and increased MME’s prescribed (SMD=0.94, p<0.001). Increased comorbidity score (OR=3.28, p<0.001) and increased 90-day MME’s prescribed (OR=1.05, p<0.001) were all found to increase the odds ratio of a postoperative opioid misuse diagnosis in patient’s undergoing shoulder surgery, while increased age (OR=0.97, p<0.001) and patient’s undergoing RCR (OR=0.79, p=0.001) were found to have a decreased odds ratio of developing a new opioid misuse diagnosis.The predictors of regional heroin use included the within-state 90-day MMEs prescribed (p=0.002). The predictors of drug overdose death included year (p<0.001), but did not include type of surgery or 90-day MMEs. CONCLUSIONOrthopedic surgeons successfully reduced the number of opioids prescribed nationally after shoulder surgeries by over 50% during our study period with similar trends seen at the state level. Our data indicate a relationship between increased opioid prescribing after shoulder surgery and heroin use. This study highlights that while progress has been made, there is evidence that opioid prescribing following shoulder surgery is associated with the more widespread opioid epidemic, and that more research is needed to further lower postoperative opioid misuse in the future.

A comparison of sofosbuvir/velpatasvir and glecaprevir/pibrentasvir for the treatment of hepatitis C infection among people who inject drugs

BackgroundTo eliminate hepatitis C (HCV) infection as a public health concern by 2030, there is a need to develop comprehensive programs among key populations such as people who use drugs (PWUD). Two highly effective regimens are available for initial therapy: glecaprevir/pibrentasvir (G/P) given as 3 tablets/day for 8 weeks and sofosbuvir/velpatasvir (S/V) given as 1 tablet/day for 12 weeks. Data evaluating the safety and efficacy comparing one regimen over another in a population of PWUD is limited. MethodsPatients were identified through outreach events. Viremic patients were offered HCV treatment within a multidisciplinary program. This retrospective comparison analysis focuses on the first 120 sequential individuals who chose either treatment and in whom a definitive outcome of treatment was available between March 1, 2019 and February 29, 2024. The primary outcomes of the analysis were cure of HCV infection and its corelates, as well as safety of the individual regimens. ResultsWe successfully identified 120 within each of the G/P and S/V treatment groups. Of those on G/P, we note 28.3 % female, 20.9 % Indigenous, 70.8 % using fentanyl, and 51.3 % with unstable housing. Of those on S/V, we note 25.8 % female, 20.8 % Indigenous, and 75 % using fentanyl and 56.7 % with unstable housing. Overall, 118 and 115 patients completed therapy on G/P and S/V, respectively. A total of 118 and 115 completed therapy on G/P and S/V, with virologic relapse documented in 3 and 2 participants on G/P and S/V, respectively. The ITT/mITT cure rates for G/P and S/V were 95.0 %/97.4 % and 94.2 %/98.3 %, respectively. There were 5 drug overdose deaths among those who initiated treatment, one on G/P and 4 on S/V. Conclusion: We have evaluated two highly effective regimens in a group of inner-city PWUD, with comparable success rates well in excess of 90 %. Our data supports the offer of both options for the treatment of PWUD with HCV infection.

Reported Non-Substance-Related Mental Health Disorders Among Persons Who Died of Drug Overdose - United States, 2022.

Drug overdose deaths remain a public health crisis in the United States; nearly 107,000 and nearly 108,000 deaths occurred in 2021 and 2022, respectively. Persons with mental health conditions are at increased risk for overdose. In addition, substance use disorders and non-substance-related mental health disorders (MHDs) frequently co-occur. Using data from CDC's State Unintentional Drug Overdose Reporting System, this report describes characteristics of persons in 43 states and the District of Columbia who died of unintentional or undetermined intent drug overdose and had any MHD. In 2022, 21.9% of persons who died of drug overdose had a reported MHD. Using the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition criteria, the most frequently reported MHDs were depressive (12.9%), anxiety (9.4%), and bipolar (5.9%) disorders. Overall, approximately 80% of overdose deaths involved opioids, primarily illegally manufactured fentanyls. Higher proportions of deaths among decedents with an MHD involved antidepressants (9.7%) and benzodiazepines (15.3%) compared with those without an MHD (3.3% and 8.5%, respectively). Nearly one quarter of decedents with an MHD had at least one recent potential opportunity for intervention (e.g., approximately one in 10 decedents were undergoing substance use disorder treatment, and one in 10 visited an emergency department or urgent care facility within 1 month of death). Expanding efforts to identify and address co-occurring mental health and substance use disorders (e.g., integrated screening and treatment) and strengthen treatment retention and harm reduction services could save lives.

Health care service utilization and drug overdose death:A national nested case-control registry study.

More knowledge is needed to identify and reach those at overdose risk with preventive measures. We examined past 12-month health service utilization, identified the most frequently utilized service, explored this utilization in more detail, and examined correlates of overdose death. A population-based nested case-control registry study including all drug overdose deaths (1 January 2010 to 31 December 2018) in Norway through the Cause of Death Registry (n = 2388). The year-, age- and gender-matched controls included through a population registry (n = 21,465). Data cross-linked with population and patient registries. Multivariable conditional logistic regression analyses estimated the likelihood of overdose death. The cases (vs. controls) attended a higher median number of services (3 vs. 1). The General Practitioner (GP) was the most utilized service. The majority (55.7%) of cases had 11-50 encounters, while the majority (60.7%) of the controls had 1-5 encounters. No high school diploma, no employment, urban living, social welfare benefits/disability pension, single-person household, recent incarceration, multiple health service utilizationand frequent GP encounters, as well psychological and certain physical diagnoses were correlates of overdose death among the GP attenders. The cases had utilized more services than the controls and the GP was the most frequently utilized service. In addition to lowsocioeconomic status, psychological and certain physical diagnoses were correlates of overdose death. This is the first national case-control registry study to document the high utilization of multiple primary and secondary health care services before drug overdose death, as well as reasons for attendance and correlates of overdose death.