scholarly journals Prevalent Misconceptions About Opioid Use Disorders in the United States Produce Failed Policy and Public Health Responses

2018 ◽  
Vol 69 (3) ◽  
pp. 546-551 ◽  
Author(s):  
Robert Heimer ◽  
Kathryn Hawk ◽  
Sten H Vermund
Keyword(s):  
United States ◽  
The United States ◽  
People Who Use Drugs ◽  
Opioid Overdose ◽  
Virus Infections ◽  
Opioid Use ◽  
Illicit Markets ◽  
Oral Consumption ◽  
Immunodeficiency Virus ◽  
Overdose Mortality

Abstract The current opioid crisis in the United States has emerged from higher demand for and prescribing of opioids as chronic pain medication, leading to massive diversion into illicit markets. A peculiar tragedy is that many health professionals prescribed opioids in a misguided response to legitimate concerns that pain was undertreated. The crisis grew not only from overprescribing, but also from other sources, including insufficient research into nonopioid pain management, ethical lapses in corporate marketing, historical stigmas directed against people who use drugs, and failures to deploy evidence-based therapies for opioid addiction and to comprehend the limitations of supply-side regulatory approaches. Restricting opioid prescribing perversely accelerated narco-trafficking of heroin and fentanyl with consequent increases in opioid overdose mortality As injection replaced oral consumption, outbreaks of hepatitis B and C virus and human immunodeficiency virus infections have resulted. This viewpoint explores the origins of the crisis and directions needed for effective mitigation.

scholarly journals Differences in Opioid Overdose Mortality Rates Among Middle-Aged Adults by Race/Ethnicity and Sex, 1999-2018

2020 ◽  
pp. 003335492096880
Author(s):  
Rachel A. Hoopsick ◽  
Gregory G. Homish ◽  
Kenneth E. Leonard
Keyword(s):  
The United States ◽  
Mortality Rates ◽  
Opioid Overdose ◽  
Research Database ◽  
Opioid Use ◽  
Middle Aged ◽  
Synthetic Opioids ◽  
Race Ethnicity ◽  
Middle Aged Adults ◽  
Overdose Mortality

Objectives The types of opioids abused in the United States have changed from prescription opioids to heroin to fentanyl. However, the types of opioids abused may differ by demographic factors, especially among middle-aged adults. We examined national trends in opioid overdose mortality rates among middle-aged adults by race/ethnicity and sex. Methods Using 1999-2018 data from the Centers for Disease Control and Prevention Wide-ranging ONline Data for Epidemiologic Research database, we examined overdose mortality rates per 100 000 population in 2018 among adults aged 45-64 that involved natural and semisynthetic opioids, heroin, synthetic opioids (excluding methadone), and methadone. We tested for significant differences in mortality rates by race/ethnicity and sex. We plotted drug-specific trends by race/ethnicity and sex from 1999 to 2018. Results In 2018, non-Hispanic White adults had the highest rates per 100 000 population of natural and semisynthetic overdose mortality (men: 8.7; women: 7.9; P < .001), and non-Hispanic Black adults had the highest rates of heroin (men: 17.7; women: 5.4; P < .001) and synthetic opioid (men: 36.0; women: 11.2; P < .001) overdose mortality. Men had significantly higher overdose mortality rates than women did for deaths involving natural and semisynthetic opioids, heroin, and synthetic opioids, but not methadone. From 1999 to 2018, mortality rates increased sharply for heroin and synthetic opioids, increased modestly for natural and semisynthetic opioids, and decreased for methadone. The greatest increases were among non-Hispanic Black men for heroin overdose (3.3 in 1999 to 17.7 in 2018) and synthetic opioid overdose (0.1 in 1999 to 36.0 in 2018). Conclusions Policy making should consider unique subgroup risks and alternative trajectories of opioid use other than people being prescribed opioids, developing opioid use disorder, subsequently moving to heroin, and then to fentanyl.

scholarly journals Factors associated with drug checking service utilization among people who use drugs in a Canadian setting

2020 ◽  
Vol 17 (1) ◽  
Author(s):  
Viseth Long ◽  
Jaime Arredondo ◽  
Lianping Ti ◽  
Cameron Grant ◽  
Kora DeBeck ◽  
...  
Keyword(s):  
Drug Market ◽  
The United States ◽  
People Who Use Drugs ◽  
Opioid Overdose ◽  
Urine Drug Screen ◽  
Opioid Use ◽  
Drug Dealing ◽  
Factors Associated ◽  
Urine Drug ◽  
Drug Checking

Abstract Background The United States and Canada are amidst an opioid overdose crisis, with the Canadian province of British Columbia (BC) among the hardest hit. In response, drug checking services (DCS) have been introduced in this setting as a novel pilot harm reduction intervention though little is known about usage rates. Therefore, we sought to identify factors associated with drug checking uptake among people who use drugs (PWUD) in Vancouver, BC. Methods Data were derived from three ongoing prospective cohort studies of PWUD in Vancouver between June and November 2018. Multivariable logistic regression was used to determine factors associated with self-reported DCS utilization in the past 6 months among participants at high risk of fentanyl exposure (i.e., those self-reporting illicit opioid use or testing positive for fentanyl via urine drug screen). Results Among 828 eligible participants, including 451 (55%) males, 176 (21%) reported recent use of DCS. In multivariable analyses, factors significantly associated with DCS utilization included: homelessness (Adjusted Odds Ratio [AOR] 1.47; 95% Confidence Interval [CI] 1.01–2.13) and involvement in drug dealing (AOR 1.59; 95% CI 1.05–2.39). Conclusions In our sample of PWUD, uptake of DCS was low, although those who were homeless, a sub-population known to be at a heightened risk of overdose, were more likely to use the services. Those involved in drug dealing were also more likely to use the services, which may imply potential for improving drug market safety. Further evaluation of drug checking is warranted.

NIOSH Responds to the U.S. Drug Overdose Epidemic

2021 ◽  
pp. 104829112110407
Author(s):  
Jamie C. Osborne ◽  
L. Casey Chosewood
Keyword(s):  
United States ◽  
Substance Use ◽  
Drug Overdose ◽  
Drug Users ◽  
Illicit Drugs ◽  
Occupational Safety ◽  
The United States ◽  
Opioid Use Disorder ◽  
Opioid Overdose ◽  
Opioid Use

The United States is experiencing an evolving and worsening drug overdose epidemic. Although the rate of drug use among workers has remained relatively stable, the risk of overdose and death among drug users has not, as illicit drugs have increased in potency and lethality. The cumulative impacts of COVID-19 and the opioid crisis increase the likelihood of illness and death among workers with opioid use disorder. Workplaces represent a critical point of contact for people living in the United States who are struggling with or recovering from a substance use disorder, and employment is a vital source of recovery “capital.” The benefits of addressing substance use in the workplace, supporting treatment, and employing workers in recovery are evident. The National Institute for Occupational Safety and Health has published research to inform policy and practice toward prevention efforts and has developed accessible resources and toolkits to support workers, employers, and workplaces in combatting the opioid overdose crisis and creating safer, healthier communities.

Human Immunodeficiency Virus Epidemic Control in the United States: An Assessment of Proposed UNAIDS Metrics, 2010–2015

2019 ◽  
Vol 69 (8) ◽  
pp. 1431-1433
Author(s):  
Karin A Bosh ◽  
John T Brooks ◽  
H Irene Hall
Keyword(s):  
United States ◽  
Human Immunodeficiency Virus ◽  
The United States ◽  
Surveillance Data ◽  
National Surveillance ◽  
Virus Infections ◽  
Epidemic Control ◽  
Immunodeficiency Virus

Abstract Epidemic control is necessary to eliminate human immunodeficiency virus infections. We assessed epidemic control in the United States by applying 4 proposed UNAIDS metrics to national surveillance data collected between 2010 and 2015. Although epidemic control in the United States is possible, progress by UNAIDS metrics has been mixed.

scholarly journals Association of Medicaid Expansion With Opioid Overdose Mortality in the United States

2020 ◽  
Vol 3 (1) ◽  
pp. e1919066 ◽  
Author(s):  
Nicole Kravitz-Wirtz ◽  
Corey S. Davis ◽  
William R. Ponicki ◽  
Ariadne Rivera-Aguirre ◽  
Brandon D. L. Marshall ◽  
...  
Keyword(s):  
United States ◽  
The United States ◽  
Opioid Overdose ◽  
Medicaid Expansion ◽  
Overdose Mortality

scholarly journals The impact of the opioid crisis on U.S. state prison systems

2021 ◽  
Vol 9 (1) ◽  
Author(s):  
Christy K. Scott ◽  
Michael L. Dennis ◽  
Christine E. Grella ◽  
Allison F. Mischel ◽  
John Carnevale
Keyword(s):  
United States ◽  
Criminal Justice ◽  
Technical Assistance ◽  
Sampling Strategy ◽  
The United States ◽  
Opioid Overdose ◽  
Opioid Use ◽  
State Prison ◽  
Prison Systems ◽  
The Impact

Abstract Background Prior studies have documented limited use of medications to treat opioid use disorders (OUD) for people incarcerated within state prisons in the United States. Using the framework of the criminal justice OUD service cascade, this study interviewed representatives of prison systems in states most heavily impacted by opioid overdose regarding the provision of medications for OUD (MOUD). Methods A stratified sampling strategy included states with high indicators of opioid-overdose deaths. Two sampling strata targeted states with: 1) OUD overdose rates significantly higher than the per capita national average; or 2) high absolute number of OUD overdose fatalities. Interviews were completed with representatives from 21 of the 23 (91%) targeted states in 2019, representing 583 prisons across these states. Interviews assessed service provision across the criminal justice OUD service cascade, including OUD screening, withdrawal management, MOUD availability and provision, overdose prevention, re-entry services, barriers, and needs for training and technical assistance. Results MOUD (buprenorphine, methadone, or naltrexone) was available in at least one prison in approximately 90% of the state prison systems and all three medications were available in at least one prison in 62% of systems. However, MOUD provision was limited to subsets of prisons within these systems: 15% provided buprenorphine, 9% provided methadone, 36% provided naltrexone, and only 7% provided all three. Buprenorphine and methadone were most frequently provided to pregnant women or individuals already receiving these at admission, whereas naltrexone was primarily used at release. Funding was the most frequently cited barrier for all medications. Conclusion Study findings yield a complex picture of how, when, and to whom MOUD is provided across prisons within prison systems in states most heavily impacted by opioid overdose in the United States and have implications for expanding availability.

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