Health Behaviors Survey among People Who Use Opioids: Protocol for Implementing Technology-Based Rapid Response Research in Community Settings (Preprint)

2020 ◽  
Author(s):  
Paula Frew ◽  
Laura Randall ◽  
Adrian King ◽  
Jay Schamel ◽  
Anne Spaulding ◽  
...  
Keyword(s):  
Los Angeles ◽  
Health Behaviors ◽  
Drug Overdose ◽  
Interpersonal Violence ◽  
Las Vegas ◽  
Future Research ◽  
Syringe Exchange ◽  
Opioid Use ◽  
Contextual Risk ◽  
Overdose Deaths

BACKGROUND In 2018, 2 million Americans met the DSM-5 diagnostic criteria for an opioid use disorder and 9.9 million had misused prescription pain relievers the previous year. Despite a rapid increase in opioid misuse, opioid use disorders, and overdoses, data is limited on the behavioral and contextual risk as well as protective factors fueling the opioid epidemic in some of the hardest hit U.S. cities – Atlanta, Los Angeles, and Las Vegas. Almost 70% of the 67,367 drug overdose deaths in the U.S. in 2018 involved an opioid. That same year, Georgia reported that over 60% of drug overdose deaths involved opioids (866), while California reported that 45% of those deaths involved opioids (> 2,400) and Nevada a total of 372 of those deaths involved an opioid. OBJECTIVE To describe characteristics and health behaviors of people who use opioids to inform public health practice, policy, and future research to mitigate the risks faced by this population experiencing multiple vulnerabilities. METHODS We implemented a community-engaged research strategy that involved development and implementation of a two-stage purposive sampling plan involving selection of partner organizations (syringe exchange programs in urban settings), and recruitment and enrollment of participants ages 18-69 years served by these organizations in Atlanta, Los Angeles, and Las Vegas from 2019-2020. The survey included a variety of measures, including those to assess general health behaviors, drug use and misuse, syringe exchange utilization, sex exchange, histories of interpersonal violence, and vaccine confidence. RESULTS The protocol was successfully implemented despite challenges like real-time technology issues and rapidly finding and surveying a difficult to reach population. We sampled 1,127 unique participants (248 in Atlanta, 465 in Los Angeles, 414 in Las Vegas). CONCLUSIONS The establishment and utilization of strong community partnerships enabled the rapid collection of data from a typically difficult to reach population. Local efforts like these are needed to develop policies and practices that promote harm reduction among people who use opioids.

scholarly journals Adolescent prescription opioid misuse, illicit opioid use and overdose

2019 ◽  
Vol 11 (1) ◽  
Author(s):  
Michele K. Bohm ◽  
Heather Clayton
Keyword(s):  
Dose Response ◽  
Drug Overdose ◽  
Prescription Opioids ◽  
Response Relationship ◽  
Opioid Use ◽  
Dose Response Relationship ◽  
Heroin Use ◽  
Synthetic Opioids ◽  
Overdose Deaths ◽  
Illicit Opioid Use

ObjectiveGiven the evolving opioid overdose epidemic, we examined the interrelationships between nonmedical use of prescription opioids and illicit opioid use in adolescents.IntroductionThe number of overdose deaths involving illicit opioids such as heroin and illicitly-manufactured fentanyl (IMF) is now higher than deaths involving prescription opioids. Adolescents misusing prescription opioids are more likely to use heroin. Although nonmedical use of prescription opioids (NUPO) among adolescents is decreasing,there is still relatively high prevalence of this behavior. Such high prevalence, along with the evolving epidemiology of the drug overdose epidemic as well as the association between NUPO and heroin use, signal that NUPO in adolescents is still an important issue. Understanding the interrelationships between NUPO and illicit opioid use in adolescents can inform prevention efforts. The purpose of this study is to: 1) present the magnitude of the drug overdose problem in adolescents, 2) compare the prevalence of heroin use and injection drug use (IDU) between students reporting NUPO and those not reporting NUPO, and 3) determine whether a dose-response relationship exists between these behaviors among adolescents. This information will be beneficial when focusing on adolescents at risk for heroin use by helping to determine whether any NUPO is associated with heroin use or if such risk is only noted at a higher frequency of NUPO behavior.MethodsWe analyzed data from two surveillance sources to capture adolescent overdose mortality and behavioral risk factors. Overdose death data for decedents aged 15 to 19 years were obtained for 2010 and 2016 from CDC WONDER, an online database with national mortality data based on death certificates for U.S. residents. We identified deaths involving prescription and illicit opioids using International Classification of Disease, 10th revision (ICD-10) codes for drug overdose deaths. Each death is assigned one underlying cause of death code and the following identified overdoses: X40-44 (unintentional), X60-64 (intentional), X85 (homicide), or Y10-14 (undetermined intent). Additionally, for overdose deaths attributed to specific drugs or drug categories, ICD-10 multiple cause of death codes were used to determine the number of deaths involving any opioid, either prescription or illicit (T40.1-T40.4 and T40.6), prescription opioids (T40.2 or T40.3), heroin (T40.1), and heroin and/or synthetic opioids (e.g., fentanyl) excluding methadone (T40.1 or T40.4). We compared the proportion of overdose deaths involving prescription opioids that also involved heroin or synthetic opioids in 2010 and 2016. The second data source, the 2017 national Youth Risk Behavior Survey (YRBS), a nationally representative cross-sectional survey of high school students, was analyzed to look at behavioral risk factors. We assessed lifetime NUPO (LNUPO) and calculated frequency of LNUPO by heroin use, injection drug use (IDU), and heroin/IDU using logistic regression models to generate adjusted prevalence ratios (aPR) and corresponding 95% confidence intervals (CI). We used linear contrast analysis to determine dose-response relationships between frequency of LNUPO and heroin use, IDU and heroin/IDU.ResultsThe number of adolescents aged 15 to 19 years who died of drug overdose increased from 831 in 2010 (3.8 per 100,000) to 873 in 2016 (4.1 per 100,000). While the proportion of overdose deaths involving prescription opioids declined during this time period, the proportion involving heroin and/or synthetic opioids, such as fentanyl increased. In 2016, two-thirds of overdose deaths among decedents aged 15 to 19 years involved either a prescription or illicit opioid. The percent of deaths involving prescription opioids that also involved heroin and/or synthetic opioids, such as fentanyl increased from 5% in 2010 to 25% in 2016. Using the 2017 YRBS sample, we estimate that 14% of high school students nationwide have ever used prescription opioids nonmedically in their lifetime. Compared to students reporting no LNUPO, students reporting LNUPO were more likely to report heroin use (9.2% vs. 0.4%), IDU (7.8% vs. 0.4%), and heroin/ IDU (10.1% vs. 0.7%). We observed a positive dose-response relationship with frequency of LNUPO. Adjusted prevalence ratios for heroin, IDU and heroin/IDU increased with increasing frequency of LNUPO and were even significantly higher among those reporting just one or two occasions of LNUPO than among those reporting no LNUPO.ConclusionsOur findings on opioid-involved drug overdose mortality and opioid use patterns confirm NUPO is still a concern for adolescents. We report a five-fold increase, from 2010 to 2016, in the percent of adolescent overdose deaths involving prescription opioids that also involved illicit opioids such as heroin and/or IMF. This may reflect deliberate polysubstance use among adolescents using prescription opioids nonmedically, but should also be considered in the context of stable prevalence of reported heroin use in YRBS and the National Survey on Drug Use and Health. In addition to issues with self-report bias, adolescents may not self-identify as a person who uses heroin, for example, if they unknowingly use counterfeit prescription pills that contain heroin or IMF. Health risk behaviors established in adolescence often continue into young adulthood and understanding associations between opioid initiation, misuse, and overdose is critical for prevention efforts. Although we found a dose-response relationship between the frequency of LNUPO and the prevalence of heroin and IDU, we also report significantly higher heroin use and IDU among students reporting just one or two occasions of LNUPO compared to students reporting no LNUPO. This underscores the importance of prevention efforts aimed at all adolescents who use prescription opioids nonmedically, with particular emphasis on those frequently misusing them. Clinical, community, and school-based efforts can address NUPO, noting these associations. 

scholarly journals Development and validation of an electronic health records-based opioid use disorder algorithm by expert clinical adjudication

2021 ◽  
Author(s):  
Shabbar I. Ranapurwala ◽  
Ishrat Z. Alam ◽  
Brian W. Pence ◽  
Timothy S. Carey ◽  
Sean Christensen ◽  
...  
Keyword(s):  
Opioid Use Disorder ◽  
Future Research ◽  
Opioid Use ◽  
Addiction Medicine ◽  
Diagnostic And Statistical Manual ◽  
Specificity And Sensitivity ◽  
The Us ◽  
Icd Codes ◽  
Development And Validation ◽  
Overdose Deaths

AbstractBackgroundIn the US, over 200 lives are lost from opioid overdoses each day. Accurate and prompt diagnosis of opioid use disorders (OUD) may contribute substantially to prevention of overdose deaths. However, OUD research is limited, the specificity and sensitivity of OUD ICD codes are unknown, and the ICD codes are known to underestimate OUD prevalence. We developed and validated algorithms to identify OUD from EHR data and examine validity of ICD-based definitions for OUD.MethodsThrough multiple iterations, we developed EHR-based algorithms to identify OUD. These algorithms and ICD-based OUD definition were validated against a total of 169 independent gold standard EHR chart reviews conducted by an expert adjudication panel of eight pain and addiction medicine clinical experts across four large healthcare systems. The experts relied on clinical judgement and current Diagnostic and Statistical Manual of Mental Disorders-5 criteria for making OUD diagnoses.ResultsOf the 169 EHR charts, 81 (48%) were reviewed by more than one expert and exhibited 85% agreement between the reviewing experts. The OUD ICD codes alone had 10% sensitivity and 99% specificity, underscoring the strong potential for OUD underestimation in studies depending on ICD codes alone. In comparison, after four iterations, the algorithms identified OUD with a 23% sensitivity and 98% specificity.Conclusions and RelevanceThis is the first study to evaluate the validity of OUD ICD codes and develop validated EHR-based algorithms to address OUD underestimation. This work has the potential to inform future research on early intervention and prevention of OUD.

Identification of Distinct Etiologies across Prescription Misuse and Illicit Drug Use: Opioids and Stimulants Compared

2020 ◽  
Author(s):  
Genevieve Fullerton Dash ◽  
Nicholas G. Martin ◽  
Arpana Agrawal ◽  
Michael Lynskey ◽  
Wendy S. Slutske
Keyword(s):  
Illicit Drugs ◽  
Genetic Influence ◽  
Prescription Opioid ◽  
Future Research ◽  
Opioid Use ◽  
Stimulant Use ◽  
Drug Classes ◽  
Illicit Use ◽  
Prescription Opioid Misuse ◽  
Illicit Opioid Use

Background. Drug classes are grouped based on their chemical and pharmacological properties, but prescription and illicit drugs differ in other important ways. Opioid and stimulant classes contain prescription and illicit forms differentially associated with salient risk factors (common route of administration, legality), making them useful comparators for examining the potential differences in the etiological influences on (mis)use of prescription and illicit drugs. Methods. 2,410 individual Australian twins (Mage=31.77 [SD=2.48]; 67% women) were interviewed about prescription misuse and illicit use of opioids and stimulants. Univariate and bivariate biometric models partitioned variances and covariances into additive genetic, shared environmental, and unique environmental influences across drug types. Results. Variation in the propensity to misuse prescription opioids was primarily attributable to genes (37%) and unique environment (59%). Illicit opioid use was attributable to shared (71%) and unique (29%) environment. Prescription stimulant misuse was primarily attributable to genes (78%) and unique environment (21%). Illicit stimulant use was influenced by genes (48%), and shared (29%) and unique environment (23%). There was evidence for genetic influence common to both stimulant types, but limited evidence for genetic influence common to both opioid types. Conclusions. Prescription opioid misuse may share little genetic influence with illicit opioid use. Future research may consider avoiding unitary drug classifications, particularly when examining genetic influences.

scholarly journals Confronting Two Crises: The COVID-19 Pandemic, the Opioid Epidemic, and the Industrial Hygienist

2021 ◽  
pp. 104829112110295
Author(s):  
Jonathan Rosen ◽  
Peter Harnett
Keyword(s):  
Disease Control ◽  
Drug Overdose ◽  
Industrial Hygiene ◽  
Prevention Programs ◽  
Opioid Epidemic ◽  
Opioid Misuse ◽  
Opioid Crisis ◽  
The Impact ◽  
Overdose Deaths ◽  
Industrial Hygienist

This article was originally written for and published in the January 2021 issue of The Synergist, a monthly publication of the American Industrial Hygiene Association. The article addresses the convergence of the COVID-19 and opioid crises, the impact of the opioid crisis on the workplace and workers, and the role that industrial hygienists can play in developing workplace programs to prevent and respond to opioid misuse. While the article is specifically written for industrial hygienists, the review and recommendations will be useful to others who are developing workplace opioid prevention programs. Note that the data presented in this article were current as of January 2021. Centers for Disease Control and Prevention’s latest available data are for the twelve-month period ending October 2020 and include 88,990 total overdose deaths and 91,862 predicted, when reporting is completed. Source: https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm (accessed on 15 June 2021).

Championing Change to Save Lives: A Call to Action to Implement Reforms to Increase Use of Medications to Treat Opioid Use Disorder in Correctional Settings

2020 ◽  
pp. 073401682098162
Author(s):  
Sonia L. Canzater ◽  
Regina M. LaBelle
Keyword(s):  
Standard Of Care ◽  
Opioid Use Disorder ◽  
Correctional Facilities ◽  
Evidence Based ◽  
Opioid Use ◽  
Call To Action ◽  
Evidence Based Treatment ◽  
High Prevalence ◽  
Correctional Settings ◽  
Overdose Deaths

The disproportional rates of opioid use disorder (OUD) in U.S. correctional facilities make them prime intervention points to treat OUD utilizing medication to treat opioid use disorder (MOUD), the evidence-based clinical standard of care. MOUD has been shown to be effective to support recovery and reduce recurrence of OUD, overdose deaths, and recidivism for justice-involved persons both while incarcerated and once they reenter their communities. Despite the high prevalence, most jails and prisons do not offer MOUD. Litigation has spurred expanded access in more facilities, but widespread MOUD access can only become a reality through a comprehensive effort of corrections officials, medical experts, advocates, legislators, and other champions to raise awareness and affect ideological and policy change. It is a legal and ethical imperative that the lives of justice-involved persons not be jeopardized by the lack of evidence-based treatment for OUD in correctional settings.

scholarly journals Visualization approaches to support healthy aging: A systematic review

2016 ◽  
Vol 23 (3) ◽  
pp. 600 ◽  
Author(s):  
Uba Backonja ◽  
Nai-Ching Chi ◽  
Yong Choi ◽  
Amanda K Hall ◽  
Thai Le ◽  
...  
Keyword(s):  
Older Adults ◽  
Health Behaviors ◽  
Healthy Aging ◽  
A Priori ◽  
Aging In Place ◽  
Future Research ◽  
Health Technologies ◽  
Data Visualizations ◽  
Informatics Tools

Background: Health technologies have the potential to support the growing number of older adults who are aging in place. Many tools include visualizations (data visualizations, visualizations of physical representations). However, the role of visualizations in supporting aging in place remains largely unexplored.Objective: To synthesize and identify gaps in the literature evaluating visualizations (data visualizations and visualizations of physical representations), for informatics tools to support healthy aging.Methods: We conducted a search in CINAHL, Embase, Engineering Village, PsycINFO, PubMed, and Web of Science using a priori defined terms for publications in English describing community-based studies evaluating visualizations used by adults aged ≥65 years.Results: Six out of the identified 251 publications were eligible. Most studies were user studies and varied methodological quality. Three visualizations of virtual representations supported performing at-home exercises. Participants found visual representations either (a) helpful, motivational, and supported their understanding of their health behaviors or (b) not an improvement over alternatives. Three data visualizations supported understanding of one’s health. Participants were able to interpret data visualizations that used precise data and encodings that were more concrete better than those that did not provide precision or were abstract. Participants found data visualizations helpful in understanding their overall health and granular data.Conclusions: Studies we identified used visualizations to promote engagement in exercises or understandings of one’s health. Future research could overcome methodological limitations of studies we identified to develop visualizations that older adults could use with ease and accuracy to support their health behaviors and decision-making.

scholarly journals Investigating Community Pharmacy Take Home Naloxone Dispensing during COVID-19: The Impact of One Public Health Crisis on Another

Pharmacy ◽  
2021 ◽  
Vol 9 (3) ◽  
pp. 129
Author(s):  
George Daskalakis ◽  
Ashley Cid ◽  
Kelly Grindrod ◽  
Michael A. Beazely
Keyword(s):  
Public Health ◽  
Community Pharmacy ◽  
Online Survey ◽  
Comfort Level ◽  
Future Research ◽  
Health Crisis ◽  
Public Health Crisis ◽  
Pharmacy Technicians ◽  
The Impact ◽  
Overdose Deaths

A recent report found that the number of opioid-related deaths in Ontario in the first 15 weeks of the COVID-19 pandemic was 38.2% higher than in the 15 weeks before the pandemic. Our study sought to determine if pharmacy professionals self-reported an increase or decrease in naloxone provision due to the pandemic and to identify adjustments made by pharmacy professionals to dispense naloxone during the pandemic. A total of 231 Ontario community pharmacy professionals completed an online survey. Pharmacy professionals’ barriers, facilitators, and comfort level with dispensing naloxone before and during the pandemic were identified. The sample consisted of mostly pharmacists (99.1%). Over half (51.1%) reported no change in naloxone dispensing, while 22.9% of respondents reported an increase and 24.7% a decrease. The most common adjustments made during the pandemic were training patients how to administer naloxone over video or phone, delivering naloxone kits, and pharmacy technicians offering naloxone at prescription intake. Over half (55%) of participants said the top barrier for dispensing was that patients did not request naloxone. Naloxone distribution through pharmacies could be further optimized to address the increased incidence of overdose deaths during the pandemic. Future research should investigate the reasons for changes in naloxone dispensing.

Effectiveness of Digital Health Interventions on Unintentional Injury, Violence, and Suicide: Meta-Analysis

2020 ◽  
pp. 152483802096734
Author(s):  
Mengtong Chen ◽  
Ko Ling Chan
Keyword(s):  
Interpersonal Violence ◽  
Care Delivery ◽  
Digital Health ◽  
Meta Analysis ◽  
Random Effect ◽  
Unintentional Injury ◽  
Health Interventions ◽  
Effect Sizes ◽  
Future Research ◽  
Face To Face

Digital technologies are increasingly used in health-care delivery and are being introduced into work to prevent unintentional injury, violence, and suicide to reduce mortality. To understand the potential of digital health interventions (DHIs) to prevent and reduce these problems, we conduct a meta-analysis and provide an overview of their effectiveness and characteristics related to the effects. We searched electronic databases and reference lists of relevant reviews to identify randomized controlled trials (RCTs) published in or before March 2020 evaluating DHIs on injury, violence, or suicide reduction. Based on the 34 RCT studies included in the meta-analysis, the overall random effect size was 0.21, and the effect sizes for reducing suicidal ideation, interpersonal violence, and unintentional injury were 0.17, 0.24, and 0.31, respectively, which can be regarded as comparable to the effect sizes of traditional face-to-face interventions. However, there was considerable heterogeneity between the studies. In conclusion, DHIs have great potential to reduce unintentional injury, violence, and suicide. Future research should explore DHIs’ successful components to facilitate future implementation and wider access.

scholarly journals Longitudinal Tracking of Vape Shop Compliance With State Business Regulations Within Southern California Ethnic Neighborhoods During the COVID-19 Pandemic

2021 ◽  
Vol 44 (1) ◽  
pp. 87-92
Author(s):  
Donna Medel ◽  
Artur Galimov ◽  
Leah Meza ◽  
Jane K. Steinberg ◽  
Carla J. Berg ◽  
...  
Keyword(s):  
Los Angeles ◽  
Southern California ◽  
Ethnically Diverse ◽  
Ethnic Communities ◽  
Contextual Risk ◽  
Business Operations ◽  
Longitudinal Tracking ◽  
Business Regulations ◽  
Stage 1 ◽  
Vape Shops

The overall aim of this study is to examine vape shop business operations during COVID-19 among a cohort of 88 vape shops in the Greater Los Angeles area in Southern California, located in ethnically diverse communities. A total of six web- and/or phone-based assessments were conducted over a 12-week period (April 1, 2020–June 10, 2020), extending from the mandated closure of nonessential businesses (Stage 1; Assessments 1–3) to the reopening of nonessential sectors (Stage 2; Assessments 4–6), to evaluate business operations (open and closure statuses). The proportion of vape shops found to be noncompliant with the Governor’s executive order (i.e., open) during Stage 1 gradually increased from 54 (61.4%) at Assessment 1 (week of April 1, 2020) to 58 (65.9%) at Assessment 3 (week of April 29, 2020). Moreover, vape shops located in Hispanic/Latino and Korean/Asian communities (vs. those in non-Hispanic White and African American communities) were more likely to stay open both during and after the shutdown at Assessments 1 and 6. More specifically, vape shops located in Hispanic/Latino communities were significantly more likely to offer walk-in service during Assessment 1 (during the shutdown), and vape shops in Hispanic/Latino and Korean/Asian were significantly more likely to offer walk-in service during Assessment 6 (after the re-opening). This study demonstrates high rates of noncompliance with shutdown orders among vape shops located in ethnic communities, thus suggesting higher contextual risk factors of COVID-19 exposure among certain ethnic communities.

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