Opioid-related Overdose Deaths Research Articles

State naloxone co-prescribing laws show mixed effects on overdose mortality rates

Objective To examine the relative changes in opioid overdose mortality rates between states that have and have not adopted naloxone co-prescribing laws. Methods We performed a synthetic control analysis. National Vital Statistics data for the years 2012–2018 were analysed, and five states with naloxone co-prescribing laws were examined: Arizona, Florida, Rhode Island, Vermont, and Virginia. Opioid overdose-related deaths were identified through cause-of-death ICD-10 codes. Results Our pooled analysis for all opioid-related deaths showed no significant changes in opioid-related mortality rates in treated states, post naloxone co-prescribing law adoption (−0.05; 95% CI: −0.43, 0.33). Rates of other and unspecified narcotic-related mortality rates in Rhode Island were found to have decreased post-law adoption (−0.13; 95% CI: −0.25, −0.00). Conclusions These findings suggest that naloxone co-prescribing laws were not associated with changes to overall opioid overdose mortality rates, post-law adoption, during the study period. However, Rhode Island did see a decrease in other and unspecified narcotic-related mortality rates post-law adoption. This is perhaps due to the comprehensive nature of the state's law. As overall rates of naloxone co-prescribing remain low, interventions to enhance naloxone prescribing and distribution may be necessary for co-prescribing laws to impact opioid-related mortality rates.

County-level factors underlying opioid mortality in the United States

Background Mortality from overdoses involving opioids in the United States (U.S.) has reached epidemic proportions. More research is needed to examine the underlying factors contributing to opioid-related mortality regionally. This study’s objective was to identify and examine the county-level factors most closely associated with opioid-related overdose deaths across all counties in the U.S. Methods: Using a national cross-sectional ecological study design, we analyzed the relationships between 17 county-level characteristics in four categories (i.e. socio-economic, availability of medical care, health-related concerns, and demographics) with opioid mortality. Data were extracted from the Robert Wood Johnson County Health Rankings aggregate database and Centers for Disease Control and Prevention (CDC)’s Wide-ranging Online Data for Epidemiological Research (WONDER) system. Results: There were 1058 counties (33.67% of 3142 nationally) with reported opioid-related fatalities. Median opioid-related mortality was 15.61 per 100,000 persons. Multivariate regression results indicate that counties with the highest opioid-related mortality had increased rates of tobacco use, HIV, Non-Hispanic Caucasians, and females and were rural areas, but lower rates of food insecurity and uninsured adults. The rates of tobacco use and HIV had the strongest association with mortality. Availability of either mental health or primary care providers were not significantly associated with mortality. Severe housing problems, high school graduation rate, obesity, violent crime, and median household income also did not contribute to county-level differences in overdose mortality. Conclusions: Future health policies should fund further investigations and ultimately address the most influential and significant underlying county-level factors associated with opioid-related mortality.

The Public Health Approach to the Worsening Opioid Crisis in the United States Calls for Harm Reduction Strategies to Mitigate the Harm From Opioid Addiction and Overdose Deaths

The opioid crisis has devastated the U.S. more than any other country, and the epidemic is getting worse. While opioid prescriptions have decreased by more than 40% from its peak in 2010, unfortunately, opioid-related overdose deaths have not declined but continued to increase. With greater scrutiny on prescription opioids, many users switched to the cheaper and more readily available heroin that drove up heroin-related overdose deaths from 2010 to peak in 2016, being overtaken by the spike in synthetic opioid (mostly fentanyl)-related overdose deaths. The surge in fentanyl-related overdose deaths since 2013 is alarming as fentanyl is more potent and deadly. One thing is certain the opioid crisis is not improving but has become dire with the surge in fentanyl-related overdose deaths. Evidence-based strategies have to be implemented in the U.S. to control this epidemic before it destroys more lives. Other countries, including European countries and Canada, have invested more in harm reduction strategies than the U.S. even though they (especially Europe) do not face anywhere near the level of crisis as the U.S. In the long-run, upstream measures (tackling the social determinants of health) are more effective public health strategies to control the epidemic. In the meantime, however, harm reduction strategies have to be employed to mitigate the harm from addiction and overdose deaths.

Community-based naloxone coverage equity for the prevention of opioid overdose fatalities in racial/ethnic minority communities in Massachusetts and Rhode Island.

Opioid-related overdose death rates continue to rise in the United States, especially in racial/ethnic minority communities. Our objective was to determine if US municipalities with high percentages of non-white residents have equitable access to the overdose antidote naloxone distributed by community-based organizations. We used community-based naloxone data from the Massachusetts Department of Public Health and the Rhode Island non-pharmacy naloxone distribution program for 2016-18. We obtained publicly available opioid-related overdose death data from Massachusetts and the Office of the State Medical Examiners in Rhode Island. We defined the naloxone coverage ratio as the number of community-based naloxone kits received by a resident in a municipality divided by the number of opioid-related overdose deaths among residents, updated annually. We used a Poisson regression with generalized estimating equations to analyze the relationship between the municipal racial/ethnic composition and naloxone coverage ratio. To account for the potential non-linear relationship between naloxone coverage ratio and race/ethnicity we created B-splines for the percentage of non-white residents; and for a secondary analysis examining the percentage of African American/black and Hispanic residents. The models were adjusted for the percentage of residents in poverty, urbanicity, state and population size. Between 2016 and 2018, the annual naloxone coverage ratios range was 0-135. There was no difference in naloxone coverage ratios among municipalities with varying percentages of non-white residents in our multivariable analysis. In the secondary analysis, municipalities with higher percentages of African American/black residents had higher naloxone coverage ratios, independent of other factors. Naloxone coverage did not differ by percentage of Hispanic residents. There appear to be no municipal-level racial/ethnic inequities in naloxone distribution in Rhode Island and Massachusetts, USA.

Broadening access to naloxone: Community predictors of standing order naloxone distribution in Massachusetts

BackgroundNaloxone is a prescription medication that reverses opioid overdoses. Allowing naloxone to be dispensed directly by a pharmacist without an individual prescription under a naloxone standing order (NSO) can expand access. The community-level factors associated with naloxone dispensed under NSO are unknown. MethodsUsing a dataset comprised of pharmacy reports of naloxone dispensed under NSO from 70% of Massachusetts retail pharmacies, we examined relationships between community-level demographics, rurality, measures of treatment for opioid use disorder, and overdose deaths with naloxone dispensed under NSO per ZIP Code-quarter from 2014 until 2018. We used a multi-variable zero-inflated negative binomial model, assessing odds of any naloxone dispensed under NSO, as well as a multi-variable negative binomial model assessing quantities of naloxone dispensed under NSO. ResultsFrom 2014–2018, quantities of naloxone dispensed under NSO and the number of pharmacies dispensing any naloxone under NSO increased over time. However, communities with greater percentages of people with Hispanic ethnicity (aOR 0.91, 95% CI 0.86–0.96 per 5% increase), and rural communities compared to urban communities (aOR 0.81, 95% CI 0.73–0.90) were less likely to dispense any naloxone by NSO. Communities with more individuals treated with buprenorphine dispensed more naloxone under NSO, as did communities with more opioid-related overdose deaths. ConclusionNaloxone dispensing has substantially increased, in part driven by standing orders. A lower likelihood of naloxone being dispensed under NSO in communities with larger Hispanic populations and in more rural communities suggests the need for more equitable access to, and uptake of, lifesaving medications like naloxone.

Opioid-Related Mortality for Individuals with Sickle Cell Disease Remains Low with No Significant Increase during 2013-2019

In 2017, the United States (US) Department of Health and Human Services declared the opioid epidemic a public health emergency due to rising opioid-related deaths. Since then, there has been increasing pressure to implement policies that regulate the use and prescribing of opioid medications. These new policies that include limiting the amount of prescribed opioids can adversely affect individuals with chronic pain conditions, such as sickle cell disease (SCD), who require opioid analgesics to manage acute and chronic pain. Individuals with SCD are also affected by racial disparities in healthcare which further exacerbate the withholding of opioid medication for these individuals when needed. Opioid-related mortality trends have not been quantified specifically for individuals with SCD. Therefore, the objective of this report is to describe opioid-related mortality trends in individuals with SCD. We hypothesize that there has been no significant increase in mortality rates due to opioids during the years 2013-2019 in individuals with SCD. Secondarily, we hypothesize that individuals with SCD do not have a higher rate of death due to opioids, compared to both Black people without SCD and White people.To determine the number of deaths and population at risk during the years 2013-2019, we used data from the Center of Disease Control and Prevention (CDC) Wide-ranging Online Data for Epidemiologic Research (WONDER) Multiple Cause of Death database. The opioid-related overdose deaths were identified using the underlying cause of death ICD-10 codes of 'X40', 'X41', 'X42', 'X43', 'X44', 'X60', 'X61', 'X62', 'X63', 'X64', 'X85', 'Y10', 'Y11', 'Y12', 'Y13', 'Y14' and multiple cause of death codes were used to identify specific drug type: 'T40.0', 'T40.1', 'T40.2', 'T40.3', 'T40.4', 'T40.6'. The deaths were determined to be among individuals with SCD if the multiple cause of death included codes for SCD 'D57.0', 'D57.1', 'D57.2', 'D57.4', 'D57.8'. Since there are no direct estimates of the SCD population in the US, we extrapolated the SCD population at risk by assuming that 1 in 365 Black people in the US have SCD. The mortality rates among Black people with SCD, Black people without SCD and White people were calculated as the crude rate per 100,000 people. The trends for death rates during 2013-2019 were evaluated using Joinpoint regression. These models fit the rates on a logarithmic scale using a series of permutation tests. We compared overall deaths over the years 2013-2019 between Black people with SCD, Black people without SCD and White people using the chi-square test in SPSS. A p-value of <0.05 was considered significant.Between 2013 and 2019 there were 273,301 recorded deaths due to opioids in the US. Of these, 236,982 (87.29%) occurred among White people, 31,316 (10.87%) among Black people without SCD, and 77 (0.03% of total opioid deaths) among Black people with SCD. Figure 1 represents mortality trends over time and Table 1 shows regression analysis and annual percentage changes in cohorts. We identified no statistically significant changes in the trend during the years 2013-2019 for Black people with SCD (annual percent change-APC=8.9%, p=0.217). However, we observe significant increasing opioid-related mortality rates for Black people without SCD (APC=24.9%, p<0.001). The mortality rates for White people increased significantly until 2017 (APC=16.0%, p=0.011) and then flattened over the years 2017-19. Overall mortality rates between the 2013-2019 period for Black people with SCD were significantly lower compared to White people (62.1 vs 93.8 per 100,000, p<0.001), but the difference was not significant in comparison to Black people without SCD (62.1 vs 69.4 per 100,000, p=0.33).Opioid-related mortality in Black people with SCD has not significantly increased over time despite overall increased opioid-related mortality in Black people without SCD and White people. Further, Black people with SCD have significantly lower opioid-related mortality rates compared to White people. These data support continued efforts are needed to ensure access to opioid analgesics for individuals with SCD and promote SCD pain treatment as per evidence-based guidelines. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

The role of law enforcement officers in responding to the opioid epidemic: A qualitative assessment

Background: Opioid-related overdose deaths continue to rise with the ongoing opioid epidemic. In response, changes in the role of law enforcement officers have included being trained to administer naloxone to reverse overdoses and offering navigation and referrals to substance use treatment. Methods: This secondary data analysis includes qualitative data from law enforcement officers collected as part of a mixed-methods needs assessment from one Kentucky county. Law enforcement officers (n = 151) responded to a confidential, online survey using Qualtrics and a subsample also completed a qualitative interview (n = 6). Open-ended questions in the online survey and interviews included how the opioid epidemic has affected the individual’s profession, specifically their role in reversing overdoses and providing referrals to individuals who misuse opioids. Results: Law enforcement officers surveyed indicated that they have expanded their professional roles to include providing naloxone to reverse opioid overdoses and referrals. While their specific roles and duties have changed to include naloxone administration to reverse opioid overdoses and providing referrals, officers felt that this was just part of their job in responding to the needs of the community. Officers reported that they have learned how to use (99%) and carry naloxone (87%) to reverse opioid related overdoses. The majority (92%) reported providing referrals (e.g., treatment and harm reduction resources) to individuals who misuse opioids. Conclusions: The opioid epidemic has changed the roles of law enforcement officers, including providing naloxone to reverse overdoses and referrals for treatment. Future research should continue to explore how substance misuse in the community changes the roles of law enforcement officers and how to best train and support officers as their roles evolve in response to these changes.

PREVALENCE, PREDICTORS, AND TRENDS OF OPIOID USE DISORDER AMONG YOUNG PEOPLE LIVING WITH HIV AGED 13-24

Over the past decade, there has been a steady uptick in overdose deaths in the United States. While most drug overdoses occur in adults, of the opioid-related overdose deaths in 2015, about 9% (4235) occurred in young people between the ages of 13 and 24 years. The CDC in 2017 reported that young people made up 21% (8164) of the 38,739 new HIV diagnoses in the United States. Young people may engage in high-risk behaviors such as needle sharing for substance use and sex without a condom, and they are less likely to utilize pre- or post-HIV exposure prophylaxis when under the influence of drugs, including opioids. Ultimately, opioid use disorder (OUD) develops among this population.

Legal System Involvement and Opioid-Related Overdose Mortality in U.S. Department of Veterans Affairs Patients

Opioid-related overdose risks are elevated after incarceration. The rates of opioid-related overdose mortality have risen in recent years, including among Veterans Health Administration patients. To inform Veteran overdose prevention, this study evaluates whether opioid-related overdose risks differ for Veterans Health Administration patients with versus those without indicators of legal system involvement. This retrospective national cohort study, conducted in 2019-2021, used Veterans Health Administration electronic health records and death certificate data from the Department of Veterans Affairs/Department of Defense Mortality Data Repository to examine opioid-related overdose mortality from January 1, 2013 through December 31, 2017. The cohort included 5,390,902 Veterans with Veterans Health Administration inpatient or outpatient encounters in 2012 who were alive as of January 1, 2013, of whom 32,284 (0.60%) patients had legal system involvement in 2012, indicated by Veterans Justice Programs outpatient encounters. Cox proportional hazards regression models assessed the associations between legal involvement and risk of opioid-related overdose mortality. There were 4,670 opioid-related overdose deaths, including 295 (6.31%) among legal-involved Veterans. Veterans with legal involvement had a higher opioid-related overdose mortality rate per 100,000 person-years (191.22, 95% CI=169.40, 213.04 vs 17.76, 95% CI=17.23, 18.29, p<0.001) and an elevated risk of opioid-related overdose mortality (adjusted hazard ratio=1.38, 95% CI=1.22, 1.57, p<0.001) compared with those without. Among Veterans receiving Veterans Health Administration care in 2012, documented legal system involvement was associated with an increased risk of opioid-related overdose mortality. Targeting overdose education and naloxone distribution programs and integrating opioid overdose prevention efforts into mental health care may reduce opioid overdose deaths among Veterans with legal involvement.

Opioid-related deaths before and after COVID-19 stay-at-home orders in Los Angeles County

BackgroundOpioid-related morbidity and mortality has increased during the COVID-19 pandemic, yet specific information about the communities most affected remains unknown. Our objective is to evaluate decedent-level associations with an opioid-related death following the implementation of stay-at-home orders in Los Angeles County. MethodsThis retrospective cohort study used data from the L.A. County Medical Examiner-Coroner to identify opioid-related deaths in 2019 and 2020. We used logistic regression to analyze the change in opioid-related deaths following a 30-day washout period after the start of stay-at-home orders. Independent variables included decedent age, gender, race and ethnicity, heroin or fentanyl present at the time of death, census tract-level education, and a scheduled drug prescription in the year before death. ResultsOpioid-related deaths in L.A. County are most common in census tracts where a small percentage of the population has a Bachelor’s degree. Following stay-at-home orders, Non-Hispanic Caucasian individuals had significantly more opioid-related deaths than Hispanic individuals (risk ratio (RR): 1.82 [95 % CI, 1.10–3.02]; P < 0.05) after adjusting for age, gender, and heroin or fentanyl use. Racial and ethnic differences in mortality were not explained by census tract-level education or recent scheduled drug prescriptions. DiscussionThere has been an alarming rise in opioid-related deaths in L.A. County during 2020. The increase in opioid-related overdose deaths following the onset of COVID-19 and related policies occurred most often among Non-Hispanic Caucasian individuals. Further research on this trend's underlying cause is needed to inform policy recommendations during these simultaneous public health crises.

Toxicological and pharmacologic sex differences in unintentional or undetermined opioid overdose death

IntroUnderstanding sex differences in toxicological etiologies of opioid-related drug overdose death could inform future sex- and gender-specific approaches to prevention and treatment. MethodsA retrospective review of accidental or undetermined opioid-involved overdose deaths in Rhode Island 2016–2019 was performed using the Rhode Island Department of Health State Unintentional Drug Overdose Reporting System (SUDORS) database. Decedent toxicology data was linked with state Prescription Drug Monitoring Program (PDMP) records. ResultsOf 766 cases in the analytical sample, 568 cases were in men (74.2%) and 198 cases were in women (25.6%). Median age was 40.0 years for males and 42.0 years for females. Statistically significant sex-differences in drug exposures were found. Compared to men, women were more likely have exposure to benzodiazepine, antipsychotic, and antidepressant drug classes and less likely to have fentanyl and alcohol co-exposure. No sex differences were found in cocaine and amphetamine exposure. Female decedents were more likely than male decedents to have a prescription for benzodiazepines or opioids in the 30 days before death (40% vs 21%). The proportion of decedents with a benzodiazepine on post-mortem toxicology testing in combination with a benzodiazepine prescription (p < 0.001) or an opioid prescription (p = 0.005) was over two times higher in women than men. ConclusionHigher rates of controlled substance prescription prior to death and prescription drug co-exposures suggest that female opioid-involved drug overdose decedents are often in contact with the health care system immediately preceding their death, presenting the opportunity to create patient-centric approaches for prevention, harm reduction, and substance use treatment.

Naloxone availability in independent community pharmacies in Georgia, 2019

BackgroundIncreasing the availability of naloxone among people who use opioids, and friends and family of past and present people who use opioids is a vitally important mission to reduce the occurrence of opioid-related overdose deaths. The purpose of this study was to determine the availability of naloxone in independent community pharmacies in Georgia. Secondary objectives include determining pharmacists’ knowledge regarding the standing order and ability to counsel regarding naloxone.MethodsA cross-sectional study using a secret shopper approach with phone contact was conducted over a period of 10 months. The study was population based and was conducted at all independent pharmacies in the state of Georgia. All independent community pharmacies in the state of Georgia were contacted and asked the naloxone questions with a 96% response rate (n = 520).ResultsFive hundred fifty-eight independent community pharmacies were called, with a 96% response rate (n = 520 pharmacies). Two hundred-twenty pharmacies reported having naloxone in stock. Of the 335 pharmacists asked, 174 (51.9%) incorrectly said that a prescription was required. The mean (SD) cash price was $148.02 (27.40), with a range of $0 to $300. Of 237 pharmacists asked who had naloxone in stock or who stated they could get naloxone in stock, 212 stated that they could demonstrate how to use it, 8 stated they could not, and 17 said that they possibly could or were unsure how to use it.ConclusionsThis study provided insight into the limited availability of naloxone at independent community pharmacies in Georgia after the standing order was issued. The majority of pharmacists at independent pharmacies in Georgia were not using the publicly available state naloxone standing order. Additionally, the low availability of naloxone and its high cost for uninsured individuals are significant structural barriers for reducing opioid-related mortality.

Willingness to use a wearable device capable of detecting and reversing overdose among people who use opioids in Philadelphia

BackgroundThe incidence of opioid-related overdose deaths has been rising for 30 years and has been further exacerbated amidst the COVID-19 pandemic. Naloxone can reverse opioid overdose, lower death rates, and enable a transition to medication for opioid use disorder. Though current formulations for community use of naloxone have been shown to be safe and effective public health interventions, they rely on bystander presence. We sought to understand the preferences and minimum necessary conditions for wearing a device capable of sensing and reversing opioid overdose among people who regularly use opioids.MethodsWe conducted a combined cross-sectional survey and semi-structured interview at a respite center, shelter, and syringe exchange drop-in program in Philadelphia, Pennsylvania, USA, during the COVID-19 pandemic in August and September 2020. The primary aim was to explore the proportion of participants who would use a wearable device to detect and reverse overdose. Preferences regarding designs and functionalities were collected via a questionnaire with items having Likert-based response options and a semi-structured interview intended to elicit feedback on prototype designs. Independent variables included demographics, opioid use habits, and previous experience with overdose.ResultsA total of 97 adults with an opioid use history of at least 3 months were interviewed. A majority of survey participants (76%) reported a willingness to use a device capable of detecting an overdose and automatically administering a reversal agent upon initial survey. When reflecting on the prototype, most respondents (75.5%) reported that they would wear the device always or most of the time. Respondents indicated discreetness and comfort as important factors that increased their chance of uptake. Respondents suggested that people experiencing homelessness and those with low tolerance for opioids would be in greatest need of the device.ConclusionsThe majority of people sampled with a history of opioid use in an urban setting were interested in having access to a device capable of detecting and reversing an opioid overdose. Participants emphasized privacy and comfort as the most important factors influencing their willingness to use such a device.Trial registrationNCT04530591.

New street drug detected in fatal overdose cases

New street drug detected in fatal overdose cases

Acceptability of technological solutions for overdose monitoring: Perspectives of people who use drugs

Introduction Rising overdose deaths are a devastating problem across the United States and Canada. Despite the availability of observed consumption sites in British Columbia (BC), data suggest people who use drugs (PWUD) alone in private residences are most at risk of overdose death. These individuals may not use consumption sites due to fear of stigmatization, lack of privacy, or personal preference. It is this population that would benefit from overdose monitoring alternatives. Methods This 2018 study employed two sources of data. (1) A provincial harm reduction distribution site client survey administered at 27 sites across BC asked about cell phone possession and functionality. (2) Structured interviews with PWUD in Vancouver gathered perspectives regarding monitoring devices and alerting systems. Results: The client survey was administered to 486 individuals. Among 443 respondents, 48% (n = 212) owned a cellphone and 68% (n = 115) of individuals with a cellphone with access to internet (n = 168) would use an application to mitigate opioid-related overdose deaths. Thirty qualitative interviews were performed; thematic analysis of the responses identified three major themes – safety, public versus private drug use, and technological monitoring and function. The relevance of technological devices was affected by the inconsistent availability of cellphones, concerns about anonymity, as well as personal comfort while using drugs. Conclusions: Technological applications may not be suitable for clients with transient lifestyles, no permanent home, and lack of consistent access to a mobile device. Thorough needs assessments, considerations of lifestyle limitations, and understanding perceptions around cellphone and overdose monitoring can increase the potential that devices will be used. Highlights 45% (n = 219) of client survey respondents owned a cellphone Out of cellphone owners, 59% (n = 102) of client survey respondents had access to internet Of 168 with internet access, 68% willing to use any applications for overdose response Applications not suitable for transient lifestyles, no permanent home, and lack of consistent access to cellphone

Pharmacist furnishing of naloxone in California: A follow-up analysis

BackgroundIncreasing naloxone access in communities has been a priority to mitigate the increasing rate of opioid-related overdose deaths. ObjectivesThe aims of this telephone survey were to estimate the availability of naloxone furnishing (provided without a prescription) by community pharmacists in California and examine the changes that occurred between 2018 and 2020. MethodsA telephone audit of a random representative sample of 1271 California licensed community pharmacies was conducted from January 22, 2020, to February 24, 2020. The results were compared with those of a survey of 1147 California licensed community pharmacies that was conducted from January 23, 2018, to February 28, 2018. The primary outcomes measured were naloxone availability without a prescription, information on formulations, cost, insurance billing, and stocking status. ResultsThere was a statistically significant increase in the furnishing of naloxone, as well as stocking and billing, in California from 2018 to 2020. Although fewer than half of the pharmacies were willing to provide naloxone without a prescription in 2020 (n = 487, 42.4%), this was an 80% increase from 2018 (P < 0.001). Of the pharmacies furnishing naloxone, many (n = 399, 81.9%) had nasal naloxone in stock, a large and statistically significant increase from 2018 when only 50.6% reported having it in stock (P < 0.001). In 2020, 90% of the pharmacies reported correctly that pharmacist-furnished naloxone could be billed to insurance compared with 56.9% in 2018 (P < 0.001). The median cash price of nasal naloxone (pack of 2) at chain pharmacies in 2020 was $131 (interquartile range [IQR] $129-$138) compared with $153 (IQR, $141-$163; P = 0.001) at independent pharmacies. ConclusionCommunity pharmacy-based access to naloxone increased in a statistically significant manner in California, although more than half of the pharmacies still do not provide such access. This study demonstrates the need for further efforts to expand community pharmacy-based access to naloxone.

Opioid use disorder and COVID-19: Implications for policy and practice.

Preliminary data suggest that opioid-related overdose deaths have increased subsequent to COVID-19. Despite national support for expanding the role of physician assistants (PAs) and NPs in serving patients with opioid use disorder, these clinicians are held to complex and stringent regulatory barriers. COVID-19 triggered significant changes from regulatory and federal agencies, yet disparate policies and regulations persist between physicians and PAs and NPs. The dual epidemics of COVID-19 and opioid use disorder highlight the inadequate infrastructure required to support patients, communities, and clinicians, and may serve as the catalyst for eliminating barriers to care.

PMH27 Impact of State Laws Restricting Opioid Prescriptions forAcute Pain on Opioid-Related Overdose Deaths Assessed Via Interrupted Time Series Analyses

Many states have implemented limitations on opioid prescriptions for patients with acute pain. Few studies have investigated relationships between prescribing restrictions and clinical outcomes. We assessed effects of acute pain prescribing restriction laws on trends in opioid-related overdose deaths among states that implemented these policies.

PNS102 Knowledge about NOVEL Opioids and Nalaxone Use Attitudes Among Pharmd Students

Since 2010, the synthetic opioid related overdose deaths have increased. Educating PharmD students who will become licensed pharmacists in the future can aid in reducing synthetic opioids misuse and fighting the opioid crisis in the United States (US). This study assessed the difference in knowledge about novel synthetic opioids (NSOs) and Kratom and difference in attitudes about naloxone use among PharmD students upon delivering an educational intervention in a public pharmacy school in Huntington, West Virginia.

Implementation of a New Hampshire community-initiated response to the opioid crisis: A mixed-methods process evaluation of Safe Station

BackgroundNew Hampshire (NH) ranked first for fentanyl- and all opioid-related overdose deaths per capita from 2014 to 2016 and third in 2017 with no rate reduction from the previous year relative to all other states in the US. In response to the opioid crisis in NH, Manchester Fire Department (MFD), the state's largest city fire department, launched the Safe Station program in 2016 in partnership with other community organizations. This community-based response to the crisis—described as a connection to recovery—focuses on reducing barriers to accessing resources for people with substance use and related problems. The study aim is to characterize the multi-organizational partnerships and workflow of the Safe Station model and identify key components that are engaging, effective, replicable, and sustainable. MethodsA mixed-methods design included: semi-structured qualitative interviews conducted with 110 stakeholders from six groups of community partners (Safe Station clients, MFD staff and leadership, and local emergency department, ambulance, and treatment partner staff); implementation and sustainability surveys (completed by MFD stakeholders); and ethnographic observations conducted at MFD. Qualitative data were content analyzed and coded using the Consolidated Framework for Implementation Research. Survey subscales were scored and evaluated to corroborate the qualitative findings. ResultsCommunity partners identified key program characteristics including firefighter compassion, low-threshold access, and immediacy of service linkage. Implementation and sustainability survey data corroborate the qualitative interview and observation data in these areas. All participants agreed that community partnerships are key to the program's success. There were mixed evaluations of the quality of communication among the organizations. ConclusionSafe Station is a novel response to the opioid crisis in New Hampshire that offers immediate, non-judgmental access to services for persons with opioid use disorders requiring community-wide engagement and communication. Data convergence provides guidance to the sustainability and replicability of the program.