Overdose Rates Research Articles

The Associations of Kratom (Mitragynine), Opioids, Other Substances, and Sociodemographic Variables to Drug Intoxication-related Mortality.

The US age-adjusted drug overdose rate increased by 298%, with fentanyl being the main contributor to drug overdose deaths. The contribution of kratom to drug overdoses or intoxication is seldom reported despite its increasing use and detection among overdose decedents. Our cross-sectional study utilized deidentified data from the Florida Department of Law Enforcement, 2020-2021 (N = 30,845). The medical examiners ascertained the exposures of interest (kratom, opioids, and other substances) and the outcome variable of drug intoxication-related mortality (DIRM) through autopsies and toxicology results. DIRM refers to any death from a substance identified as drug toxicity or intoxication. We used regression modeling to examine the association of exposure with DIRM. Five hundred fifty-one cases were confirmed kratom (mitragynine) exposures. More males died of DIRM (81.5%), primarily White (95.1%) and 35-44 years old (40.5%). Among mitragynine exposures, 484 (87.8%) died of DIRM; 36 decedents (6.5%) used kratom as the sole substance, and 515 (93%) used multiple substances; 437 (79.3%) used at least 1 opioid. The odds of dying of DIRM were 7.6 times higher among those mitragynine exposed compared with non-mitragynine exposed (univariate model) and 5.6 times higher after adjusting for confounders (multivariate model) (adjusted odds ratio = 5.6; 95% confidence interval, 4.1-7; P < 0.001). Opioid use increased the odds of dying of DIRM (adjusted odds ratio = 11.7; 95% confidence interval, 10.9-12.7; P < 0.001). Our results indicate that dozens of decedents died of kratom (mitragynine) exposures alone, which has safety implications. Co-using opioids with kratom further increased the odds of dying of DIRM, indicating that kratom may not always work as a harm-reduction agent.

Differences in heroin overdose risk associated with the unregulated drug market: Insights from a supervised injecting facility in Melbourne, Australia.

To determine the contribution that variation in the unregulated drug market has on the risk of heroin overdose across individuals with different levels of personal overdose risk. A retrospective cohort study of heroin injecting episodes and overdose cases were examined over a 12-month period between 30 June 2022 and 30 June 2023. The Medically Supervised Injecting Room in Melbourne, Australia. 1474 witnessed heroin overdose cases were examined amongst a cohort of 337 individuals who were predominantly male (n = 276, 81.7%) with a median age of 43.5years (interquartile range 37.25-49.00 years, range 20-75 years). The daily overdose rate was used to differentiate High and Low daily overdose risk categories. The number of overdose events that an individual experienced during the study period was used to differentiate people into Standard, Moderate and High personal overdose risk categories. Each overdose case was differentiated by the personal overdose risk of the individual who experienced the overdose, as well as the overdose risk of the day that overdose occurred. A stratified overdose risk profile was then derived across the nine different daily overdose risk and personal overdose risk categories. The rate of overdose approximately doubled on High overdose risk days compared with Standard overdose risk days, increasing by a factor of 2.11, 2.41 and 2.03 times for individuals in the Standard, Moderate and High personal overdose risk groups. Conversely, the rate of overdose was also substantially reduced on Low overdose risk days to a factor of 0.17, 0.28 and 0.20, respectively. Among heroin users in Melbourne, Australia, there is an approximately 10-times difference in the risk of overdose on some days compared with others, which appears to be attributable to the effects of the unregulated drug market and not the effects of variation in personal overdose risk of individuals.

COVID-19 public health restrictions and opioid overdoes: a summative content analysis of emergency medical services records in three Texas counties

BackgroundWith the broad recognition of increased U.S. opioid overdose (OOD) rates between 2020 and 2021, media, public health, and healthcare organizations have raised significant concerns over the emergence of a simultaneous COVID-19-opioid “twindemic.” Research in this area has explored the possible relationships between negative externalities associated with the pandemic and/or COVID-19 public health interventions and increased risks for opioid use and overdose alongside diminished outcomes following OOD events.MethodsThe study offers a summative content analysis of Emergency Medical Service (EMS) responses to opioid overdose (OOD) events before and after the institution of COVID-19 restrictions. Specifically, the study investigates three Texas counties to evaluate changing OOD rates, patient demographics, and OOD event features. The analysis uses a previously validated machine learning tool to identify OOD events and conducted a summative content analysis of identified events.ResultsA total of 1170 OOD responses events were identified in the three-county dataset. This includes 874 in Travis County, 242 in El Paso County, and 54 in Williamson County. Each county experienced modest changes in EMS calls for OOD events between the pre-restriction and public health restriction time periods. Travis County’s OOD event rate declined from 454 to 420. El Paso’s increased from 103 to 139, and Williamson County’s increased from 23 to 31. These changes were not significant as percentage of possible OOD events or based on by-month comparison. The notable differences between pre-restriction and public health restriction periods were significant decreases in documentation of patient race/ethnicity in Travis and Williamson Counties, significant decreases in housing insecurity and use alone in Travis County, and an increase in transport refusal after treatment in the field in Travis County.ConclusionsUltimately the results presented here problematize prevailing analyses about the so-called opioid-COVID-19 “twindemic.” The data further support emerging trends about substantial geographic variation and show some ways that COVID-19 mitigation measures may have improved conditions for some populations, particularly in terms of housing security. Additionally, the results presented here indicate that further attention should be paid to the effects of first responder stress on documentation quality.

Effects Of Medicaid Waivers On Use Of Medications For Opioid Use Disorder And Nonfatal Overdoses In 17 States.

A long-standing policy prohibits the use of federal funds for Medicaid services in Institutions for Mental Diseases (facilities with more than sixteen beds that specialize in mental health or substance use disorder treatment). Beginning in 2015, states could apply for Section 1115 Medicaid waivers, which permit federal funding for Institutions for Mental Diseases services and require improvements in opioid use disorder (OUD) treatment. Using 2016-20 Medicaid data, we compared changes in the use of medications for OUD and nonfatal overdoses in seventeen states with waivers approved during 2017-19 to changes in eighteen states without waivers. Waiver implementation was not associated with improvements in overall medication treatment, buprenorphine and naltrexone prescribing, or rates of nonfatal overdoses among Medicaid enrollees with OUD. Waiver implementation was associated with a 2.3-percentage-point increase in the use of methadone with waiver implementation, as a result of coverage changes, and a 3.7-percentage-point increase in any medication treatment among Medicaid enrollees diagnosed with severe OUD who had an inpatient or residential stay. Our findings suggest that such waivers adopted by states during 2017-19 were not associated with significant improvements in medication treatment or reductions in nonfatal opioid-related overdoses among Medicaid enrollees with OUD. However, they may have moderately improved the use of medication treatment for those with severe OUD.

Suicides and Overdoses at Work: Census of Fatal Occupational Injuries, 2011-2022

IntroductionThe worsening life expectancy of middle-aged white Americans due to suicides and substance overdoses has been hypothesized to be caused by various societal conditions. Work is a social determinant of health, but its role in this demographic shift has not been examined. This article describes the characteristics and trends of suicides and overdose fatalities occurring in U.S. workplaces among all workers between 2011 and 2022. MethodsData originated from the Census of Fatal Occupational Injury database. Fatality rates were calculated using the Current Population Survey. Fatality rates were calculated and compared among demographic and occupational groups. Annual rates were modeled with a first order auto-regressive linear regression to account for serial correlation. Analyses were conducted in 2023-2024. ResultsBetween 2011 and 2022, the rate of workplace overdose fatality rates increased from 0.05 per 100,000 workers to 0.33 - an increase of 560%. Workplace suicide rates were relatively stable (0.19 per 100,000 to 0.17). Most industries and occupations experienced significant increases in workplace overdose rates and non-significant decreases in workplace suicide rates. The largest workplace overdose rates occurred in the Transportation & Warehousing industry (0.47, 95% CI=0.27-0.67) and Farming, Fishing, & Forestry occupations (0.68, 95% CI=0.27-1.08). ConclusionsFatal workplace suicides and substance overdoses have different trends and impact industries, occupations, and demographic groups differently. The rise in workplace overdoses deserve immediate attention.

MOUD use among Hispanic clients increased post-ACA, yet differed by heritage and geographic location

BackgroundOverdose death rates for Hispanic people rose 2010-2022. Opioid overdose rates grew faster among Hispanic people than non-Hispanic White people (“White”). Medication for opioid use disorder (MOUD) is an effective but underutilized intervention for decreasing overdose risk. The Affordable Care Act (“ACA”) should have increased MOUD use, but insurance and behavioral health reforms differed by state. We examined to what extent MOUD use increased post-ACA implementation and differed for Hispanic people (overall and by heritage group) compared to White people who used opioids (“clients”). MethodsWe analyzed first annual ambulatory care episodes (TEDS-A, 2009-2019) for working-age Hispanic (N= 76,591) and White (N=444,753) clients. We categorized Hispanic clients by heritage group (Puerto Rican, Mexican, or Other Hispanic). We grouped states by Medicaid expansion status (California, Other Expansion States, and Non-Expansion States). We used logistic regression to compare the odds of MOUD use pre/post ACA within racial/heritage groups, and, separately, between racial/heritage groups using pre-ACA White clients as a reference group. We used linear probability difference-in-differences to confirm changes in MOUD use between Hispanic and White clients. ResultsAmong Hispanic clients in ambulatory care, MOUD use was lowest in the Non-Expansion States and highest in California. Nationally, only Puerto Rican and Other Hispanic heritage clients had higher odds of MOUD post-ACA compared to pre-ACA. Nationally and in Other Expansion States, Hispanic and White clients had similar increases in MOUD use post-ACA. ConclusionsMOUD use among Hispanic clients rose post-ACA, but differences remained between Hispanic heritage groups and between states.

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.

Spatial patterns of rural opioid-related hospital emergency department visits: A machine learning analysis

As opioid-related overdose emergency department visits continue to rise in the United States, there is a need to understand the location and magnitude of the crisis, especially in at-risk rural areas. We analyzed sets of ZIP code level electronic health records for emergency department visits from 6 hospitals for two rural regions of Maryland with higher opioid-related overdose rates. Analysis of the demographics of visits found Black or African American emergency department visits in both rural regions were higher than the proportion of their population per region. We trained random forest models with socio-demographic factors and health risk factors on the visits data to understand drivers and risk factors for opioid misuse. The models ranked factors relating to opioid prescribing rates, race, housing, and poor mental health as highly important. Factors associated with opioid-related overdose emergency department visits were found to vary by race, gender, and location and may provide useful insights for designing mitigation initiatives.

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.

Utilizing Academic Detailing Intervention to Increase Screening, Referral, and Treatment for Opioid Use Disorder Among Primary Care Providers in Randolph County.

Opioid use disorder is a national epidemic that has killed over one million United States residents since 1999. Randolph County, North Carolina (NC) has a significantly higher rate of drug overdose and emergency-department-related visits than the NC state average. Primary care providers are well positioned to intervene and offer screening, referral, and treatment of opioid use disorder, yet this does not often occur. This quality improvement project serves as a pilot to evaluate the effectiveness of academic detailing (AD) to increase screening, referral, and treatment of opioid use disorder as well as to increase knowledge of community resources available. Face-to-face one-to-one AD was provided to primary care providers. Content included an overview of the diagnosis, standardized screening tools, management, and community resources available for referral. Assessments pre and post were conducted to evaluate screening, referral and treatment practices, knowledge of available community resources, barriers to providing services, and satisfaction with the AD event. AD did not result in change in frequency of screening or referral for treatment for OUD. None of the providers who participated in the intervention were prescribing buprenorphine prior to the event, nor were they after the event. Results indicated that there was an increase in the knowledge level of providers after AD with a change in median knowledge level from "I know about some resources in the area" to "I am very knowledgeable about area resources." Barriers to screening, referral, and treatment were identified, with lack of time being the most frequently cited. AD did not increase screening, referral, or treatment of OUD in this pilot project. However, there was an increase in knowledge of community resources related to OUD. AD is labor and time intensive and may be difficult to scale. Providers are well positioned to impact patient lives and increase screening, referral, and treatment for OUD in primary care settings. Continued work is needed to overcome barriers for getting patients adequate OUD treatment. Additional research is needed to ascertain if varied forms of AD would be more time and cost effective.

The ABCD and HBCD Studies: Longitudinal Studies to Inform Prevention Science.

Increasing rates of overdose among U.S. adolescents and young adults, along with rising rates of emotional distress in these groups, are renewing the urgency for developmentally targeted and personalized substance use and other mental health prevention interventions. Most prevention programs recognize the unique vulnerability of childhood and adolescence and target parents and youths, addressing modifiable environmental risk and protective factors that affect behavior during periods when the brain is most susceptible to change. Until recently, a scarcity of comprehensive studies has limited a full understanding of the complexity of factors that may affect neurodevelopment, including substance exposure in pregnancy and/or subsequent substance use in adolescence, alongside their dynamic interactions with environmental factors and genetics. Two large longitudinal cohort studies funded by National Institutes of Health-the Adolescent Brain Cognitive Development (ABCD) Study and the HEALthy Brain and Child Development (HBCD) Study-are collecting data on neurodevelopment and a wide range of environmental and biological factors across the first two decades of life to build databases that will allow researchers to study how individual neurodevelopmental trajectories are influenced by drugs, adverse childhood experiences, and genetics, among other factors. These studies are already deepening the understanding of risk and resilience factors that prevention programs could target and will identify critical windows where interventions can have the most impact on an individual's neurodevelopmental trajectory. This article describes what is being learned from ABCD and expected from HBCD and how these studies might inform prevention as these children grow and more data are gathered.

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.