Overdose Rates Research Articles

Emergency department visits, inpatient hospitalizations, and non-fatal and fatal drug overdoses during COVID-19 among Veterans with opioid use disorder.

The COVID-19 pandemic had dramatic adverse impacts on people with opioid use disorder (OUD), as evidenced by significant disruptions to care and unprecedented increases in drug overdoses. In this study, we evaluated the impacts of COVID-19 on utilization of emergency and inpatient care, and fatal and non-fatal overdoses among veterans with OUD. We used Veterans Health Administration (VHA) electronic medical record and mortality data to compare emergency department (ED) visits, inpatient hospitalizations, and fatal and non-fatal overdoses between a pandemic-exposed cohort of veterans with OUD observed both pre- and post-pandemic onset (n = 53,803; observed January 2019-March 2021) to a matched pre-pandemic control group (n = 53,803; observed October 2017-December 2019). Compared to pre-pandemic trends, there were significant decreases in the odds of ED and inpatient admissions and total number of ED and inpatient admissions during COVID-19. There was a significant decrease in the odds of having a recorded non-fatal overdose. The odds of overdose death increased during the pandemic compared to pre-pandemic trends. We observed significant decreases in the utilization of ED and inpatient care services, and fewer non-fatal overdoses, post-pandemic onset. Healthcare disruptions limiting access to emergency and inpatient care could account for the lower number of recorded non-fatal overdoses, potentially reflecting an underestimate of risk. In contrast, fatal overdoses increased during the pandemic compared to pre-pandemic trends. Lower utilization of emergency and inpatient care, and higher rates of fatal overdoses during the pandemic, suggest an exacerbation of unmet treatment need post-pandemic onset.

Naloxone Distribution Models in the United States: A Scoping Review.

Increasing naloxone distribution is a high priority means to mitigating opioid overdose rates in the United States. Since a variety of naloxone distribution models exist, with differences in infrastructure and funding between states and health-systems, it is important to review their differences and understand the strengths and barriers to widespread implementation of each model. The following 4 databases were searched for articles reporting on naloxone distribution models: (1) PubMed/Medline (National Library of Medicine), (2) Embase (Elsevier), (3) Scopus (Elsevier), and (4) the Cochrane library. Reports from all years written in English that discussed naloxone distribution models in the United States were included, as were all study designs. Of 5825 articles initially identified, 173 were selected for full text review. Of these, 49 met full criteria and were included for data extraction and analysis. Most distribution models occurred in community-based opioid education and naloxone distribution programs and in community pharmacies via a standing order/statewide protocol. Most programs reported strengths related to feasibility, but frequently reported cost as a limitation. Fewer studies described distribution models in ambulatory care or hospital settings, though these studies also highlighted strengths related to feasibility, particularly with support from working partners, and when utilizing an interprofessional care approach. Few studies reported health/economic outcomes data associated with naloxone distribution, such as changes in the number of patient/layperson access, the number of opioid overdose reversals, or cost-savings. This review outlines the many ways in which naloxone is distributed in the United States and emphasizes a need for improved outcomes data collecting/reporting in the various settings where naloxone is distributed. This would allow for future studies to evaluate which distribution model factors are associated with improvements in health outcomes, such as increased layperson access, and lower opioid overdose/mortality rates.

Risk of Opioid Overdose Associated with Concomitant Use of Methadone and Statins.

Methadone has a high potential for risky drug-drug interactions that can lead to opioid overdose, yet evidence on the magnitude of this risk remains limited. Since methadone is transported via P-glycoprotein (P-gp), the use of statins that inhibit P-gp may elevate methadone plasma concentrations, potentially leading to opioid overdose. We explored this hypothesis by examining whether concomitant use of methadone and P-gp-inhibiting statins was associated with opioid overdose. Using Medicaid claims data from 2003 to 2020, we conducted a cohort study among new concomitant users of methadone and statins. We compared overdose rates among individuals exposed to P-gp-inhibiting statins (simvastatin, atorvastatin, or lovastatin) vs. those exposed to rosuvastatin (negative control), adjusting for baseline covariates. We identified 69,263 individuals newly exposed to methadone and a statin of interest; the overall incidence rate of opioid overdose was 26.0 per 1,000 person-years. Adjusted hazard ratios (HRs) for methadone + P-gp-inhibiting statins consistently showed no association, ranging from 0.76 (95% CI = 0.48-1.22) for atorvastatin to 0.78 (95% CI = 0.50-1.22) for simvastatin, compared with methadone + rosuvastatin. Similar results were observed in sensitivity analysis that treated all P-gp-inhibiting statins as a single exposure group, as well as analyses stratified by baseline diagnosis of opioid use disorder or overdose, the duration of baseline methadone use, and calendar year intervals. Our findings suggest that concomitant use of methadone with simvastatin, atorvastatin, or lovastatin is not associated with the risk of opioid overdose compared to concomitant use of methadone and rosuvastatin.

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.

The association between glucose-dependent insulinotropic polypeptide and/or glucagon-like peptide-1 receptor agonist prescriptions and substance-related outcomes in patients with opioid and alcohol use disorders: A real-world data analysis.

This study aimed to estimate the strength of association between prescriptions of glucose-dependent insulinotropic polypeptide (GIP) and/or glucagon-like peptide-1 receptor agonists (GLP-1 RA) and the incidence of opioid overdose and alcohol intoxication in patients with opioid use disorder (OUD) and alcohol use disorder (AUD), respectively. This study also aimed to compare the strength of the GIP/GLP-1 RA and substance use-outcome association among patients with comorbid type 2 diabetes and obesity. A retrospective cohort study analyzing de-identified electronic health record data from the Oracle Cerner Real-World Data. About 136 United States of America health systems, covering over 100 million patients, spanning January 2014 to September 2022. The study included 503 747 patients with a history of OUD and 817 309 patients with a history of AUD, aged 18 years or older. The exposure indicated the presence (one or more) or absence of GIP/GLP-1 RA prescriptions. The outcomes were the incidence rates of opioid overdose in the OUD cohort and alcohol intoxication in the AUD cohort. Potential confounders included comorbidities and demographic factors. Patients with GIP/GLP-1 RA prescriptions demonstrated statistically significantly lower rates of opioid overdose [adjusted incidence rate ratio (aIRR) in OUD patients: 0.60; 95% confidence interval (CI) = 0.43-0.83] and alcohol intoxication (aIRR in AUD patients: 0.50; 95% CI = 0.40-0.63) compared to those without such prescriptions. When stratified by comorbid conditions, the rate of incident opioid overdose and alcohol intoxication remained similarly protective for those prescribed GIP/GLP-1 RA among patients with OUD and AUD. Prescriptions of glucose-dependent insulinotropic polypeptide and/or glucagon-like peptide-1 receptor agonists appear to be associated with lower rates of opioid overdose and alcohol intoxication in patients with opioid use disorder and alcohol use disorder. The protective effects are consistent across various subgroups, including patients with comorbid type 2 diabetes and obesity.

Overdose as a complex contagion: modelling the community spread of overdose events following law enforcement efforts to disrupt the drug market

BackgroundThe opioid overdose mortality crisis in the USA is an ongoing public health epidemic. Ongoing law enforcement strategies to disrupt local unregulated drug markets can have an iatrogenic effect of...

Evaluation of an emergency department-based approach to reduce subsequent opioid overdoses.

The purpose of this study was to determine the association of a multi-pronged treatment program in emergency department (ED) patients with an acute presentation of opioid use disorder (OUD) on the rate of subsequent opioid overdose (OD). This approach included ED-initiated take-home naloxone, prescription buprenorphine, and an ED-based peer support and recovery program. This was a retrospective observational analysis of adult patients presenting to the ED at a large urban hospital system from November 1, 2017 to March 17, 2023. Patients with an ED discharge diagnosis of OD or OUD were included. Outcomes determined were subsequent 90-day OD and 180-day OD death. Post hoc analyses were performed to identify intervention utilization throughout the study period including the COVID-19 pandemic as well as ED characteristics associated with subsequent OD and OD death. Statistical comparisons were made using logistic regression and chi-squared test. A total of 2634 patients presented to the ED with an opioid OD or diagnosis of OUD. Subsequent 90-day OD decreased significantly over time (11.5%-2.3%, odds ratio [OR] 0.85, confidence interval [CI] 0.82-0.89). No single intervention was independently associated with 90-day OD or 180-day OD death. Resource utilization was stable during the COVID-19 pandemic and increased afterward. A higher buprenorphine fill-rate among all patients and the Back race subgroup was associated with a decrease in 90-day OD. Subsequent OD and OD death decreased over time after implementation of a multi-pronged treatment program to ED patients with OUD. No single intervention was associated with a decrease of subsequent OD or OD death.

Impact of California's naloxone co-prescription law on emergency department visits, 30-day mortality, and prescription patterns.

Opioid overdose is a public health epidemic adversely impacting individuals and communities. To combat this, California passed a law mandating that prescribers offer a naloxone prescription in certain circumstances. Our objective was to evaluate associations with California's naloxone prescription mandate and emergency department (ED) overdose visits/hospitalizations, opioid and naloxone prescribing, and 30-day mortality. This retrospective cohort study included data from January 1, 2018, to December 31, 2019, and included all Kaiser Permanente Southern California (KPSC) members aged >10 years across 15 KPSC EDs. Exposure was defined as presentation to the ED within the study period. The primary outcome was ED visits for opioid overdose pre- and post-implementation of California's naloxone prescription mandate. A total of 1.1 million ED visits (534K pre/576K post) were included in the study population. ED opioid overdose visits were 344 (6.4/10,000) pre-policy and 351 (6.1/10,000) post-policy implementation, while non-opioid overdose visits were 309 (5.8/10,000) pre-implementation and 411 (7.1/10,000) post-implementation. The unadjusted rate of visits with opioid prescriptions decreased significantly (14.9% pre to 13.5% post) after implementation. ED naloxone prescriptions increased substantially (104 pre vs. 6031 post). Primary adjusted interrupted time series analysis found no statistical difference between monthly opioid overdose visits pre versus post (odds ratio 1.02, 95% confidence interval [CI] 0.98‒1.07). Difference-in-differences analysis revealed no significant changes in hospitalization (coefficient [CE]=‒0.05, 95% CI=‒0.11 to 0.02) or 30-day mortality (CE=‒0.01, 95% CI=‒0.03 to 0.01). This study revealed that the implementation of California's naloxone prescription mandate was associated with significantly increased naloxone prescribing and decreased opioid prescribing, but no significant change in ED opioid overdose visits, hospitalizations, or 30-day mortality. This indicates that increasing naloxone prescribing alone may not be sufficient to lower opioid overdose rates.

Health service utilization, substance use treatment response, and death in patients with opioid use disorder and comorbid hepatitis C findings from prospective cohort study with administrative database linkage

BackgroundAmong patients with opioid use disorder (OUD), high rates of overdose and death have been reported in subgroups with Hepatitis C Virus (HCV). Evidence on the comorbid effect of HCV on clinical and substance use trajectories has been limited by small sample sizes, short follow-up, and heavy reliance on administrative data which lacks granularity on important prognostic factors. Additionally, few studies include populations on substance use treatment. AimTo establish the impact of HCV exposure (antibody positivity) on health care utilization patterns, substance use treatment response, and death in a cohort of patients with OUD on opioid agonist therapy (OAT). MethodsThis multi-center prospective cohort study recruited adult patients with OUD on OAT from 57 substance use treatment centers in Ontario, Canada. The study collected substance use outcomes, and classified patients with ≥50 % positive opioid urine screens over one year of follow-up as having poor treatment response. Additional data obtained via linkage with ICES administrative databases evaluated the relationship between HCV status, healthcare service utilization, and death over 3 years of follow-up. Multiple logistic regression models established the adjusted impact of HCV on various outcomes. ResultsAmong recruited participants (n = 3430), 44.10 % were female with a mean age of 38.64 years (Standard deviation: 10.96). HCV was prevalent in 10.6 % of the cohort (n = 365). Methadone was used most often (83.9 %, n = 2876), followed by sublingual buprenorphine (16.2 %, n = 554). Over the three-year follow-up, 5.3 % of patients died (n = 181). Unadjusted results reveal rates of hospitalization (all-cause, mental-health related, critical care) and emergency department visits (mental health-related), were significantly higher among HCV patients. Associations diminished in adjusted models. Active injection drug use exhibited the highest predictive risk for all outcomes. ConclusionA high degree of acute physical and mental illness and its resulting health service utilization burden is concentrated among patients with OUD and comorbid HCV. Future research should explore the role for targeted interventions and how best to implement integrated healthcare models to better address the complex health needs of HCV populations who inject drugs.

Semaglutide and Opioid Overdose Risk in Patients With Type 2 Diabetes and Opioid Use Disorder.

This cohort study uses emulation target trial methods to evaluate whether semaglutide is associated with lower rates of opioid overdose among patients with type 2 diabetes (T2D) and opioid use disorder (OUD).

Factors Associated With the Availability of Medications for Opioid Use Disorder in US Jails

In 2023, more than 80 000 individuals died from an overdose involving opioids. With almost two-thirds of the US jail population experiencing a substance use disorder, jails present a key opportunity for providing lifesaving treatments, such as medications for opioid use disorder (MOUD). To examine the prevalence of MOUD in US jails and the association of jail- and county-level factors with MOUD prevalence using a national sample. This survey study used a nationally representative cross-sectional survey querying 1028 jails from June 2022 to April 2023 on their provision of substance use disorder treatment services. The survey was conducted via mail, phone, and the internet. County-level data were linked to survey data, and binary logistic regressions were conducted to assess the probability that a jail offered any treatment and MOUD. A stratified random sample of 2791 jails identified by federal lists of all jails in the US was invited to participate. Staff members knowledgeable about substance use disorder services available in the jail completed the survey. US Census region, urbanicity, jail size, jail health care model (direct employees or contracted), county opioid overdose rate, county social vulnerability (measured using the Centers for Disease Control and Prevention 2020 Social Vulnerability Index summary ranking, which ranks counties based on 16 social factors), and access to treatment in the county were assessed. Availability of any type of substance use disorder treatment (eg, self-help meetings), availability of MOUD (ie, buprenorphine, methadone, and naltrexone) to at least some individuals, and availability of MOUD to any individual with an OUD were assessed. Of 2791 invited jails, 1028 jails participated (36.8% response rate). After merging the sample with county data, 927 jails were included in analysis, representative of 3157 jails nationally after weighting; most were from nonmetropolitan counties (‭1756 jails [55.6%; 95% CI, 52.3%-59.0%]) and had contracted health care services (1886 jails [59.7%; 95% CI, 56.5%-63.0%]); fewer than half of these jails (1383 jails [43.8%; 95% CI, 40.5%-47.1%]) offered MOUD to at least some individuals, and 405 jails (12.8%; 95% CI, 10.7% to 14.9%) offered MOUD to anyone with an OUD. Jails located in counties with lower social vulnerability (adjusted odds ratio per 1-percentile increase = 0.28; 95% CI, 0.19-0.40) and shorter mean distances to the nearest facility providing MOUD (adjusted odds ratio per 1-SD increase, 0.80; 95% CI, 0.72-0.88) were more likely to offer MOUD. In this study, few jails indicated offering frontline treatments despite being well positioned to reach individuals with an OUD. These findings suggest that efforts and policies to increase MOUD availability in jails and the surrounding community may be associated with helping more individuals receive treatment.

"Before medically advised" departure from hospital and subsequent drug overdose: a population-based cohort study.

A substantial number of hospital admissions end in patient-initiated departure before medical treatment is complete. Whether "before medically advised" (BMA) discharge increases the risk of subsequent drug overdose remains uncertain. We performed a retrospective cohort study using administrative health data from a 20% random sample of residents of British Columbia, Canada. We focused on nonelective, nonobstetric hospital stays occurring between 2015 and 2019. We used survival analysis to compare the rate of fatal or nonfatal illicit drug overdose in the first 30 days after BMA discharge versus the rate after physician-advised discharge. Overall, 6440 of 189 808 (3.4%) hospital stays ended in BMA discharge. Among 820 overdoses occurring in the first 30 days after any hospital discharge, 755 (92%) involved patients with a history of substance use disorder. Unadjusted overdose rates were 10-fold higher after BMA discharge than after physician-advised discharge, and BMA discharge was associated with subsequent overdose even after adjustment for potential confounders (crude incidence, 2.8% v. 0.3%; adjusted hazard ratio [HR] 1.58; 95% confidence interval [CI] 1.31-1.89). Before medically advised discharge was associated with increases in subsequent emergency department visits (adjusted HR 1.92; 95% CI 1.83-2.02) and unplanned hospital readmissions (adjusted HR 2.07; 95% CI 1.96-2.19), but there was no significant association with the uncommon outcomes of fatal overdose and all-cause mortality. Before medically advised departure is associated with an increased risk of drug overdose in the first 30 days after discharge. Improved treatment of substance use disorder, expanded access to overdose prevention services, and new means of postdeparture outreach should be explored to reduce this risk.

Means to an end: Characteristics and follow-up of emergency department patients with a history of suicide attempt via medication overdose.

Availability and accessibility of a wide range of medications may be a contributing factor to rising medication-related overdose (OD) rates. Treatment for both suicide attempts (SAs) and ODs often occurs in the emergency department (ED), highlighting its potential as a screening and intervention point. The current study aimed to identify sociodemographic and clinical characteristics of individuals who reported SA via medication OD compared to other methods and to examine how these patients' suicide severity and behaviors differed over 12-month post-ED follow-up. Data were analyzed from Phases 1 and 2 of the Emergency Department Safety Assessment and Follow-up Evaluation multicenter study (N = 1376). Participants with a history of SA (n = 987) were categorized based on whether they indicated a past medication-related SA via OD. Of participants with history of SA, 62.7% (n = 619) reported medication OD for either their most serious or their most recent SA. Multivariate analyses indicated female birth sex, diagnosis of bipolar disorder, and having some college education were significantly associated with membership in the medication OD attempt group (p <0.05). Of those who attempted suicide over the 12-month follow-up, nearly 60% of participants in the medication OD attempt group reported a subsequent SA via OD over follow-up. However, nearly half (46.5%) of participants with no medication OD at baseline also reported medication OD at follow-up. Among patients presenting to the ED, females, individuals with bipolar disorder, and patients with a college education, respectively, may be at highest risk for SAs via medication OD. Prospectively, medication OD appears to be a frequent method, even among individuals with no prior attempt via OD, as demonstrated by the high percentage of patients who did not have a medication OD at baseline, but reported a medication OD during follow-up.

Trends in Nonfatal Overdose Rates Due to Alcohol and Prescription and Illegal Substances in Colombia, 2010-2021.

Objectives. To examine drug overdoses in Colombia by type of substance, sex, age, and intent using data from a health surveillance system from 2010 to 2021. Methods. We characterized data by year, type of substance, and sociodemographic variables. We calculated age-adjusted overdose rates by substance type, sex, age groups, and intent. We used Poisson regression models to examine trend differences across sex and age groups. Results. Age-adjusted rates of drug overdoses increased from 8.51 to 40.52 per 100 000 during 2010 to 2021. Men, compared with women, had higher overdose rates for every substance, except for opioids and psychotropics. Drug overdose rates involving cannabis and stimulants increased steadily until 2017 but decreased afterward. Overdose rates involving psychotropic medication increased greatly during 2018 to 2021, mainly because of intentional overdoses in young women. Conclusions. Overdoses involving illegal drugs decreased in recent years in Colombia; however, the continuous increase in intentional psychotropic overdose rates highlights the need for prevention efforts to curb this trend. Health surveillance systems are an important tool that can guide overdose prevention efforts in countries with limited data resources. (Am J Public Health. Published online ahead of print September 12, 2024:e1-e9. https://doi.org/10.2105/AJPH.2024.307786).

Prevalence and correlates of fentanyl test strip use among people who use drugs in Rhode Island

BackgroundIllicitly manufactured fentanyl accounts for a majority of overdose fatalities in the US. Research has demonstrated that fentanyl test strips (FTS) help people who use drugs (PWUD) avoid unintended exposure to fentanyl and overdose. This study assesses characteristics associated with FTS use among PWUD in Rhode Island. Such findings may shed light on whether there are subgroups of PWUD who are less likely to be using FTS and therefore may benefit from their use. MethodsFrom September 2020 - February 2023, participants were recruited to participate in RAPIDS, a clinical trial assessing whether FTS provision can reduce overdose rates. Baseline data were used to assess correlates of lifetime FTS use through bivariable and multivariable analyses. We also examined drug testing patterns relating to FTS use in the past month. ResultsOf 509 people enrolled, 376 (73.9 %) had heard of FTS before enrollment. Among this group, 189 (50.3 %) reported lifetime FTS use and 98 (26.1 %) reported use in the last month. In bivariable analyses, lifetime injection drug use, responding to an overdose, and drug selling were associated with FTS use. Solitary drug use was not associated with FTS uptake. In the multivariable analysis, gender and lifetime naloxone administration were associated with FTS use. Of those who used FTS in the past month, 76.5 % had at least one test that was positive for fentanyl. ConclusionsWe found high uptake of FTS use among PWUD in Rhode Island. Our results also suggest a need for targeted outreach to increase FTS uptake among sub-groups of PWUD. Clinical trial registrationThe Rhode Island Prescription and Illicit Drug Study is a registered clinical trial, NCT043722838

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.

Evaluating fentanyl test strips as a harm reduction strategy in rural and urban counties: study protocol for a randomized controlled trial

BackgroundOpioid-related fatalities are a leading cause of death in Ohio and nationally, with an increasing number of overdoses attributable to fentanyl. Rapid fentanyl test strips can identify fentanyl and some fentanyl analogs in urine samples and are increasingly being used to check illicit drugs for fentanyl before they are used. Fentanyl test strips are a promising harm reduction strategy; however, little is known about the real-world acceptability and impact of fentanyl test strip use. This study investigates fentanyl test strip distribution and education as a harm reduction strategy to prevent overdoses among people who use drugs.MethodsThe research team will recruit 2400 individuals ≥ 18 years with self-reported use of illicit drugs or drugs purchased on the street within the past 6 months. Recruitment will occur at opioid overdose education and naloxone distribution programs in 16 urban and 12 rural Ohio counties. Participating sites will be randomized at the county level to the intervention or non-intervention study arm. A brief fentanyl test strip educational intervention and fentanyl test strips will be provided to participants recruited from sites in the intervention arm. These participants will be eligible to receive additional fentanyl test strips for 2 years post-enrollment. Participants recruited from sites in the non-intervention arm will not receive fentanyl test strip education or fentanyl test strips. All participants will be followed for 2 years post-enrollment using biweekly, quarterly, and 6-month surveys. Primary outcomes include (1) identification of perceived barriers and facilitating factors associated with incorporating fentanyl test strip education and distribution into opioid overdose education and naloxone distribution programs; (2) differences in knowledge and self-efficacy regarding how to test drugs for fentanyl and strategies for reducing overdose risk between the intervention and non-intervention groups; and (3) differences in non-fatal and fatal overdose rates between the intervention and non-intervention groups.DiscussionFindings from this cluster randomized controlled trial will contribute valuable information about the feasibility, acceptability, and impact of integrating fentanyl test strip drug checking in rural and urban communities in Ohio and help guide future overdose prevention interventions.Trial registrationClinicalTrials.gov NCT05463341. Registered on July 19, 2022. https://clinicaltrials.gov/study/NCT05463341

Racial Differences in Medications for Opioid Use Disorder Initiation in a Carceral Setting.

The opioid overdose crisis significantly affects marginalized communities, with people of color experiencing higher rates of overdose and barriers to treatment. The syndemic of opioid use disorder and mass incarceration exacerbates racial health disparities. Some carceral facilities offer medication for addiction treatment, though no significant research explores differences in type of treatment uptake by race in these settings. This study focuses on the racial differences in medications for opioid use disorder (MOUD) preferences among incarcerated individuals. A retrospective cohort study was conducted at the Rhode Island Department of Corrections (RIDOC), examining MOUD-type preferences (buprenorphine or methadone) among incarcerated individuals. The study utilized RIDOC electronic medical records from January 1, 2017 to December 31, 2022, involving 3533 unique incarceration events. Participants were categorized by race (White vs non-White) and MOUD status (new initiation vs community continuation), with logistic regression models. The study found no direct racial disparity in preferences for MOUD type. However, an interaction between race and MOUD initiation status significantly influenced MOUD-type preference. Among those initiating MOUD during incarceration, non-White individuals were more likely to choose buprenorphine compared to their White counterparts. This research provides new insights into the intersection of race, incarceration, and MOUD preferences. While direct racial disparities in MOUD type were not observed, the analysis uncovered a notable interaction effect: race influences the relationship between MOUD initiation status and the selected MOUD treatment during incarceration. Specifically, data demonstrate that the likelihood of choosing buprenorphine varies significantly based on both racial background and whether the treatment was initiated during incarceration or in the community. Further research is needed in different geographic settings to understand the broader implications to help guide equitable healthcare delivery in jails and prisons.

Maryland opioid overdose deaths from 2018 to 2022: occupational patterns and their sociodemographic variations

IntroductionWe aimed to describe the occupational pattern of opioid overdose deaths in Maryland between 2018 and 2022 and determine the occupations at higher risk of opioid overdose death.MethodsThe sample included...

Barriers and Facilitators to Accessing Opioid Agonist Therapy for Street-involved Adolescents and Young Adults in Vancouver.

Opioid agonist therapy (OAT) remains the first-line therapy for people with opioid use disorder. Whereas overdose rates among adolescents and young adults (AYAs) remain high, little is known about their access to OAT. Therefore, we sought to evaluate factors that shape access to OAT among AYAs aged 14 to 26 years. Data were derived from the At-Risk Youth Study, a prospective cohort study that involves street-involved AYAs who use illicit substances in Vancouver, Canada. Generalized estimating equations were used to identify factors associated with OAT enrollment from September 2005 to October 2021. A total of 759 AYAs reported at least weekly opioid or OAT use, with a median age of 23 years and 65.7% self-identifying as male. At baseline, 147 participants (19.4%) were on OAT, and another 199 (26.2%) initiated OAT during study follow-up (median number of follow-up visits, 5 [Q1-Q3, 2.5-8]). In a multivariable analysis, being <19 years old (adjusted odds ratio [AOR], 0.40; 95% confidence interval [CI], 0.23-0.71), Indigenous ancestry (OR, 0.72; 95% CI, 0.52-1.00), homelessness (AOR, 0.65; 95% CI, 0.54-0.77), drug dealing (AOR, 0.73; 95% CI, 0.61-0.87), daily opioid use (AOR, 0.47; 95% CI, 0.40-0.55), and nonfatal overdose (AOR, 0.73; 95% CI, 0.60-0.89) were negatively associated with OAT use. This study identified a low rate of OAT access among AYAs. Adolescents and young adults were less likely to be on OAT if they were <19 years old, Indigenous, and possessed certain risk markers. These findings highlight the need for mitigation strategies to facilitate OAT access for this population and for additional harm reduction measures to support AYAs who do not want to use OAT.