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Lack of access to resources is a "fundamental cause" of poor HIV outcomes across the care cascade globally and may have the greatest impact on groups with co-existing marginalized identities. In a sample of people living with HIV (PWH) who inject drugs and were not on antiretroviral therapy (ART), we explored associations between access to resources and HIV severity. Fundamental Cause Theory (FCT) sees socioeconomic status/access to resources as a root cause of disease and emphasizes that individuals with limited resources have fewer means to mitigate health risks and implement protective behaviors, which ultimately generates disparities in health outcomes. Guided by the FCT, we hypothesized that resource depletion (primary aim) and lower income (secondary aim) were associated with increased HIV severity. Using baseline data from the Linking Infectious and Narcology Care (LINC-II) trial of ART-naive PWH who inject drugs in St. Petersburg, Russia (n = 225), we examined the association between "past year resource runout" (yes vs. no) and "low-income (< 300 USD a month)" and the outcome HIV severity (CD4 count, continuous). We fit two separate linear regression models adjusted for gender, age, time since HIV diagnosis, and prior ART use. Participants had a mean age of 37.5 years and were 60% male. Two thirds (66%) reported resource depletion, and 30% had income below 300 USD a month. Average CD4 count was 416 cells/mm3 (SD 285). No significant association was identified between either resource depletion or low-income and HIV severity (adjusted mean difference in CD4 count for resource depletion: - 4.16, 95% CI - 82.93, 74.62; adjusted mean difference in CD4 count for low-income: 68.13, 95% CI - 15.78, 152.04). Below-average income and running out of resources were common among PWH who inject drugs and are not on ART in St. Petersburg, Russia. Resource depletion and low-income were not significantly associated with HIV disease severity as captured by CD4 count. The nuanced relationship between socioeconomic status and HIV severity among people with HIV who inject drugs and not on ART merits further examination in a larger sample.
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Infecciones por VIH , Clase Social , Abuso de Sustancias por Vía Intravenosa , Humanos , Masculino , Femenino , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/epidemiología , Federación de Rusia/epidemiología , Abuso de Sustancias por Vía Intravenosa/epidemiología , Abuso de Sustancias por Vía Intravenosa/complicaciones , Adulto , Recuento de Linfocito CD4 , Persona de Mediana Edad , Factores Socioeconómicos , Accesibilidad a los Servicios de SaludRESUMEN
BACKGROUND: The potential public health benefits of supervised smoking facilities (SSFs) are considerable, and yet implementation of SSFs in North America has been slow. We conducted this study to respond to significant knowledge gaps surrounding SSF utilization and to characterize substance use, harm reduction practices, and service utilization following the onset of the COVID-19 pandemic. METHODS: A questionnaire was self-administered at a single site by 175 clients using an outdoor SSF in Vancouver, Canada, between October-December 2020. Questionnaire responses were summarized using descriptive statistics. Multinomial logistic regression techniques were used to examine factors associated with increased SSF utilization. RESULTS: Almost all respondents reported daily substance use (93% daily use of opioids; 74% stimulants). Most used opioids (85%) and/or methamphetamine (66%) on the day of their visit to the SSF. Respondents reported drug use practice changes at the onset of COVID-19 to reduce harm, including using supervised consumption sites, not sharing equipment, accessing medically prescribed alternatives, cleaning supplies and surfaces, and stocking up on harm reduction supplies. Importantly, 45% of SSF clients reported using the SSF more often since the start of COVID-19 with 65.2% reporting daily use of the site. Increased substance use was associated with increased use of the SSF, after controlling for covariates. CONCLUSIONS: Clients of the SSF reported increasing not only their substance use, but also their SSF utilization and harm reduction practices following the onset of COVID-19. Increased scope and scale of SSF services to meet these needs are necessary.
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COVID-19 , Sobredosis de Droga , Trastornos Relacionados con Sustancias , Humanos , Estudios Transversales , Analgésicos Opioides , Accesibilidad Arquitectónica , Reducción del Daño , Pandemias/prevención & control , COVID-19/prevención & control , FumarRESUMEN
Objectives: Eating and substance use disorders (SUD) are generally treated separately, leaving eating disorders (ED) overlooked within substance use treatment. The frequent co-occurrence of SUD and ED is well documented. Despite their many similarities and frequent co-occurrence, these two disorder types continue to be largely treated separately-either sequentially, with the most severe disorder addressed first, or concurrently but in separate programs. Our study, therefore, responds to this lacuna of data on patient and provider treatment needs for integrated ED and SUD treatment, centering the perspectives of women with lived experience of ED and SUD to support the development of therapeutic groups for women in treatment programs. Methods: This study was designed as a needs and assets assessment to determine the needs and priorities of women with concurrent ED and SUD for developing group programs. Participants for the needs assessment included both staff members (n = 10) and women receiving treatment (n = 10) who were recruited from a 90-day residential treatment program for women with SUD in British Columbia, Canada. Interviews and focus groups conducted with participants were audio-recorded and transcribed verbatim. Data were thematically analyzed and coded using Dedoose software. Results: Six key themes emerged from the qualitative data and were organized into sections with sub themes. An overarching premise from both staff and program participants was the need for concurrent therapeutic programming, nutritional support, and medical monitoring. The six discrete themes that were elicited included the similarities between ED and SUD, gaps in treatment, community support, family involvement, program participant treatment suggestions, staff treatment suggestions, and family involvement. Conclusions: Throughout this qualitative study, the need for screening and assessment of both disorders along with integrated treatment was stressed by participants, both program participants and staff alike. These findings complement current literature and suggest that pursuing concurrent treatment design may be helpful in addressing unmet program participant needs and could provide a more holistic framework for recovery.
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Trastornos de Alimentación y de la Ingestión de Alimentos , Trastornos Relacionados con Sustancias , Humanos , Femenino , Trastornos Relacionados con Sustancias/complicaciones , Trastornos Relacionados con Sustancias/epidemiología , Trastornos Relacionados con Sustancias/terapia , Trastornos de Alimentación y de la Ingestión de Alimentos/complicaciones , Trastornos de Alimentación y de la Ingestión de Alimentos/epidemiología , Trastornos de Alimentación y de la Ingestión de Alimentos/terapia , Investigación Cualitativa , Tratamiento Domiciliario , CanadáRESUMEN
Recent frameworks, models, and reports highlight the critical need to address social determinants of health for achieving health equity in the United States and around the globe. In the United States, data play an important role in better understanding community-level and population-level disparities particularly for local health departments. However, data-driven decision-making-the use of data for public health activities such as program implementation, policy development, and resource allocation-is often presented theoretically or through case studies in the literature. We sought to develop a preliminary model that identifies the factors that contribute to data-driven decision-making in US local health departments and describe relationships between them. Guided by implementation science literature, we examined organizational-level capacity and individual-level factors contributing to using data for decision-making related to social determinants of health and the reduction of county-level disparities. This model has the potential to improve implementation of public health interventions and programs aimed at upstream structural factors, by elucidating the factors critical to incorporating data in decision-making.
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Equidad en Salud , Determinantes Sociales de la Salud , Humanos , Estados Unidos , Formulación de Políticas , Salud Pública , Asignación de RecursosRESUMEN
OBJECTIVES: This study examined whether distinct factors exist among public health skills, measured through the Public Health Workforce Interests and Needs Survey (PH WINS). Understanding how workforce training needs group is important for developing targeted and appropriate public health workforce training sessions. DESIGN: Exploratory factor analysis was used to examine public health skills among tier 1 staff (nonmanagers) and a combined group of tier 2 and 3 staff (managers and executives). SETTING: Data for this study come from the 2017 PH WINS, which assessed public health workforce perceptions of training needs, workplace environment, job satisfaction, perceptions about national trends, and demographics. The analysis included 22 items. PARTICIPANTS: All public health staff in participating agencies were eligible to complete the survey. The national data set included participants from 47 state health agencies, 26 large local health departments (LHDs), and 71 mid-sized LHDs across all 10 Health and Human Services regions in the United States (including LHDs from all states). The analytic sample was n = 9630 in tier 1, n = 4829 in tier 2, and n = 714 in tier 3 staff. MAIN OUTCOME MEASURE: Three factors were identified within the skills portion of PH WINS, using exploratory factor analysis. To interpret retained factors, the following parameters were used: factor loadings greater than 0.4, factor cross-loadings less than 0.4 or higher than loadings on other factors, and communalities greater than 0.5. RESULTS: Factors included (1) data and systems thinking, (2) planning and management, and (3) community collaboration, with slight variation in item loadings between tier 1 and tier 2 and 3 staff analyses. CONCLUSION: This study was the first known factor analysis of the training needs and workforce skills portion of PH WINS in the published literature. This study advances our conceptualization of public health workforce skills and has the potential to shape future critical workforce training development.
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Fuerza Laboral en Salud , Salud Pública , Humanos , Estados Unidos , Recursos Humanos , Encuestas y Cuestionarios , Análisis FactorialRESUMEN
BACKGROUND AND OBJECTIVES: Legalization of recreational cannabis is occurring across the United States, with some controversy. To understand the range of issues that can arise when such a policy change is enacted, we examined portrayal of legalization at the local level by studying newspaper articles in Calgary, Alberta, shortly before and after cannabis legalization in Canada. METHOD: We searched the largest-circulation newspaper for cannabis-related items and analyzed for content and slant toward cannabis legalization. RESULTS: Among 165 items, business/economics (70.9% of items) and legalization (69.7%) were most frequent, with health only 29.7%. Across all items, the slant was more approval (44.2%) than disapproval (23.0%). DISCUSSION AND CONCLUSIONS: When cannabis was legalized, the local newspaper focused more on economic aspects of legalization rather than about health issues. Further research can determine the generalizability of the findings to other locales and provide comparison as other similar policy changes roll out. SCIENTIFIC SIGNIFICANCE: The study provides new information on what happens when drug policies are enacted. Documenting the media portrayal of substance use policies is a promising tool.
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Cannabis , Analgésicos , Canadá , Comercio , Humanos , Legislación de Medicamentos , Estados UnidosRESUMEN
PURPOSE: This systematic review summarizes and presents the current state of research quantifying the relationship between mental disorder and overdose for people who use opioids. METHODS: The protocol was published in Open Science Framework. We used the PECOS framework to frame the review question. Studies published between January 1, 2000, and January 4, 2021, from North America, Europe, the United Kingdom, Australia, and New Zealand were systematically identified and screened through searching electronic databases, citations, and by contacting experts. Risk of bias assessments were performed. Data were synthesized using the lumping technique. RESULTS: Overall, 6512 records were screened and 38 were selected for inclusion. 37 of the 38 studies included in this review show a connection between at least one aspect of mental disorder and opioid overdose. The largest body of evidence exists for internalizing disorders generally and mood disorders specifically, followed by anxiety disorders, although there is also moderate evidence to support the relationship between thought disorders (e.g., schizophrenia, bipolar disorder) and opioid overdose. Moderate evidence also was found for the association between any disorder and overdose. CONCLUSION: Nearly all reviewed studies found a connection between mental disorder and overdose, and the evidence suggests that having mental disorder is associated with experiencing fatal and non-fatal opioid overdose, but causal direction remains unclear.
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Sobredosis de Droga , Sobredosis de Opiáceos , Trastornos Psicóticos , Analgésicos Opioides/efectos adversos , Sobredosis de Droga/epidemiología , Europa (Continente) , Humanos , Trastornos Psicóticos/tratamiento farmacológicoRESUMEN
BACKGROUND: Taxane acute pain syndrome (TAPS) is a clinically significant side-effect of taxane chemotherapy, often described as arthralgia and myalgia that occurs 2-3 days after infusion. The aim of this study was to assess pain descriptors used by patients during their experience of TAPS. METHODS: A clinical prospective cohort study was conducted on breast cancer patients who had not received prior chemotherapy and were asked to complete diaries on three consecutive docetaxel treatment cycles on days 1-7, 14, and 21 (acute phase). Questionnaires to assess pain severity, descriptors of pain, and the interference in activities due to pain were adapted from the Brief Pain Inventory and the McGill Pain Questionnaire. Telephone questionnaire follow-up was done at 1, 3, 6, 9, and 12 months following docetaxel (delayed phase). RESULTS: The most commonly used descriptor for acute and chronic pain was "aching" (90-96%). However, in the delayed phase of the study, "burning" (32-50%), "radiating" (39-48%), and "sharp" (40-69%) were used more often. In both acute and chronic pain phases, most patients experienced moderate/severe pain regardless of the location. Pain in cycle 1 was predictive of pain in subsequent taxane cycles (p < 0.0001). Pain in cycle 3 was predictive of chronic pain (p < 0.002). CONCLUSIONS: The descriptors used by patients experiencing chemotherapy-induced pain (ChIP) may be reflective of the underlying mechanisms. It is suspected that TAPS initiates as an acute inflammatory pain, which over time develops into neuropathic pain, known as chemotherapy-induced peripheral neuropathy (CIPN). However, the subjective pain experience varies from patient to patient.
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Dolor Agudo/inducido químicamente , Neoplasias de la Mama/complicaciones , Hidrocarburos Aromáticos con Puentes/efectos adversos , Taxoides/efectos adversos , Adulto , Anciano , Anciano de 80 o más Años , Neoplasias de la Mama/tratamiento farmacológico , Femenino , Humanos , Persona de Mediana Edad , Estudios ProspectivosRESUMEN
PURPOSE: To investigate the natural history of taxane-associated acute pain syndrome (TAPS) in a docetaxel patient cohort and to examine the long-term manifestation of TAPS. PATIENTS AND METHODS: For three consecutive treatment cycles, taxane-naive breast cancer patients completed diaries on days 1-7, 14, and 21 and telephone questionnaires 1, 3, 6, 9, and 12 months following treatment. Questionnaires to assess pain and interference were adapted from the Brief Pain Inventory. To examine the experience of arthralgia and myalgia as one syndrome, information on patient experiences with arthralgia or myalgia was elicited separately in order to determine how closely experiences of each toxicity correlated with each other. A ≥2 point increase from baseline was defined as an arthralgia or myalgia "pain flare," and only those with "flare" were included in calculations of incidence. RESULTS: A total of 278 patients were accrued. Thirty-eight patients were omitted due to missing information, and 24 patients were omitted due to metastatic disease, for a total of 216 patients overall and 188 in the docetaxel cohort. A total of 74.5% of docetaxel patients experienced joint pain flare, and 78.2% experienced muscle pain flare at some point in the overall course of three treatment cycles. Joint and muscle pain peaked on days 4-5 for each cycle, and median pain severity for both joint and muscle pain was 4/10 during the 21-day period. Median onset of joint pain flare was 3 days for cycle 1 and 4 days for cycles 2 and 3, with an average median duration of 4 days. Median onset of muscle pain flare was 4 days for all three cycles, with a median duration of 4 days for cycles 1 and 2, and 5 days for cycle 3. Both joint and muscle pain persisted 1 year after treatment in approximately half of responding patients. CONCLUSION: This study documents the significant incidence of TAPS in patients treated with docetaxel chemotherapy and shows a long-term persistence of the syndrome.
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Artralgia/inducido químicamente , Neoplasias de la Mama/tratamiento farmacológico , Mialgia/inducido químicamente , Taxoides/efectos adversos , Adulto , Anciano , Anciano de 80 o más Años , Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Dolor en Cáncer/inducido químicamente , Docetaxel , Femenino , Humanos , Incidencia , Persona de Mediana Edad , Estudios Prospectivos , Encuestas y Cuestionarios , Taxoides/administración & dosificaciónRESUMEN
PURPOSE: The purpose of this study was to assess which pain intensity dimension scale (worst, least, average, or current pain) from the Brief Pain Inventory (BPI) correlates most highly with functional interference scores in patients experiencing taxane-induced arthralgia and myalgia. METHODS: Breast cancer patients scheduled to receive docetaxel, paclitaxel, or albumin-bound paclitaxel (nab-paclitaxel) were enrolled in the study. Patients completed an initial baseline questionnaire and subsequently filled out a diary based on the BPI on days 1-7, 14, and 21 for three consecutive treatment cycles. Pain scores for worst, least, average, and current pain intensity dimensions as well as pain interference scores were recorded in the diaries and questionnaires using the BPI. Worst, least, average, and current pain scores were correlated with functional pain interference scores using Spearman's rank correlation coefficients. A general linear mixed model of each functional interference measure was performed over time for cycles 1-3 with each pain intensity dimension scale. RESULTS: Among worst, average, least, and current joint pain dimensions, average joint pain scores correlated best with all BPI interference responses while average muscle pain scores correlated best with all BPI interference responses except for sleeping probability and normal work. CONCLUSION: We recommend the BPI scale measuring average pain for future studies evaluating pain scores in patients experiencing taxane-induced arthralgia and myalgia.
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Artralgia/inducido químicamente , Mialgia/inducido químicamente , Dimensión del Dolor/métodos , Taxoides/efectos adversos , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Encuestas y CuestionariosRESUMEN
Objective The aim of this study was to develop an appraisal tool to support and promote clear, accurate and transparent standards and consistency when conducting, reporting and assessing community-based research. Design Current recommendations for developing reporting guidelines was used with three key differences: (1) an analysis of existing guides, principles and published literature about community engagement, involvement and participation in research using situational and relational maps; (2) feedback and pilot-testing by a community-based research team; and (3) testing the utility and usability of the appraisal tool. Results After a series of iterative revisions, the resulting Community-Partnered Research (CPR) appraisal tool emerged into three products: an elaborate prospective format, a basic retrospective format, and a supplemental checklist format. All three versions of the CPR appraisal tool consist of 11 main question items with corresponding prompts aimed to facilitate awareness, accountability, and transparency about processes and practices employed by professional researchers and community co-researchers throughout four phases of research: (1) partnership and planning, (2) methods, (3) results and (4) sustainment. Conclusion We hope that introducing this tool will contribute to shifting individual and systematic processes and practices towards equitable partnerships, mutual trustworthiness and empowerment among professional researchers and community co-researchers and, in turn, improving the quality of co-created knowledge that benefits communities and creates social change.
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Investigación Participativa Basada en la Comunidad , Humanos , Proyectos de Investigación , Participación de la Comunidad/métodosRESUMEN
Objective: School-Based Health Centers (SBHCs) can reduce barriers to accessing care for school-aged children and adolescents. However, current practices related to screening for and responding to social determinants of health (SDOH) in SBHCs are unknown. Our study sought to understand SBHC staff's knowledge related to SDOH, and their screening and referral practices for addressing SDOH. Methods: This study was conducted with all SBHCs in King County, Washington (n = 30 clinics operated by n = 8 agencies) between January-March 2022. Data were collected using a web-based questionnaire, distributed to all provider and clinical care staff (n = 222) in these SHBCs. Results: While respondents had strong generalized knowledge regarding SDOH and how they impact health, they were less confident about the specific SDOH impacting the students they serve. Many health limiting and promoting factors are screened for by respondents; however, there was no standardization related to screening and referral practices across SBHCs or agencies. Respondents had suggestions on how to improve screening methodology and ensure that existing practices adequately assess the SDOH impacting student's lives. There was no clearly identified mechanism for making and following up on referrals. Respondents felt that there were either not or only sometimes enough resources available to meet student's needs. Conclusion: SBHCs advance health and educational outcomes for students, yet SDOH are inconsistently assessed and addressed within SBHCs in King County. Standardizing processes for SDOH assessment and referral can help SBHCs develop practices that are in the best service of equity for their student populations.
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BACKGROUND: Inadequate income is associated with higher likelihood of experiencing a substance use disorder (SUD). This study tests whether the earned income tax credit (EITC), which issues supplemental income for workers with children in the U.S., is associated with lower rates of SUD and fatal overdose. METHODS: We examined the effects of state-level refundable EITC presence and generosity (i.e., state EITC rate as a % of federal rate) on SUD-related outcomes (SUD prevalence and intentional and unintentional fatal overdose) using a difference-in-difference methodology, with both two-way fixed-effects models and event study plots. Several sensitivity analyses were conducted to assess the robustness of findings. Five data sources were used to create a combined state-level longitudinal dataset. RESULTS: We did not find significant effects of refundable EITC presence or generosity on unintentional or intentional fatal overdose or SUD prevalence in two-way models. Event study models detected a very slight upward shift in SUD prevalence following refundable EITC implementation (not seen in sensitivity analyses) and no significant effects of EITC implementation on any of the fatal overdose outcomes. CONCLUSIONS: Evidence regarding income support programs is being highly sought by policy makers as income support programs have become increasingly popular policy levers since the start of the COVID-19 pandemic. Our study indicates EITC policies likely have no impact on SUD or overdose, however, other income support programs without family restrictions are important to investigate further.
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Sobredosis de Droga , Impuesto a la Renta , Trastornos Relacionados con Sustancias , Humanos , Trastornos Relacionados con Sustancias/epidemiología , Trastornos Relacionados con Sustancias/economía , Sobredosis de Droga/epidemiología , Sobredosis de Droga/mortalidad , Sobredosis de Droga/economía , Estados Unidos/epidemiología , Masculino , Femenino , Adulto , Renta , PrevalenciaRESUMEN
BACKGROUND: With substance use rates increasing in Sub-Saharan Africa (SSA), an understanding of the accessibility and effectiveness of rehabilitative services for people who use alcohol and other drugs (AOD) is critical in the global efforts to diagnose and treat substance use disorders (SUD). This scoping review seeks to address the gaps in knowledge related to the types of research that have been conducted regarding inpatient or residential SUD treatment in SSA, the settings in which the research was conducted, and the study countries. METHODS: A search of three databases, PubMED, Scopus, and African Index Medicus, was conducted for publications related to the treatment of SUD in inpatient or residential settings in SSA. Articles were screened at the title/abstract level and at full text by two reviewers. Articles eligible for inclusion were original research, conducted in SSA, published in English, included populations who received or were currently receiving treatment for SUD in inpatient or residential settings, or documented demand for SUD services. RESULTS: This scoping review included 82 studies originating from 6 countries in SSA. Three themes emerged within the literature: access and demand for inpatient and residential SUD treatment, quality and outcomes of SUD treatment, and descriptions of the services offered and staffing of these facilities. Barriers to access include financial barriers, limited availability of services, and geographic concentration in cities. Women were shown to access residential and inpatient SUD treatment at lower rates than men, and certain racial groups face unique language and financial barriers in accessing services. Studies indicate mixed success of inpatient and residential SUD treatment in sustained SUD remission for patients. CONCLUSION: There are significant gaps in the literature, driven by a lack of longitudinal studies focused on patient outcomes following treatment and the use of a narrow definition of treatment success. Both structural and non-structural barriers, such as stigma and discrimination, are barriers to access. Further research is needed to evaluate approaches to mitigate these barriers and expand access to residential and inpatient SUD treatment.
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Accesibilidad a los Servicios de Salud , Trastornos Relacionados con Sustancias , Masculino , Humanos , Femenino , Pacientes Internos , Hospitalización , Trastornos Relacionados con Sustancias/terapia , África del Sur del SaharaRESUMEN
Introduction: Recent policy changes in Washington State presented a unique opportunity to pair evidence-based interventions with first responder services to combat increasing opioid overdoses. However, little is known about how these interventions should be implemented. In partnership with the Research with Expert Advisors on Drug Use team, a group of academically trained and community-trained researchers with lived and living experience of substance use, we examined facilitators and barriers to adopting leave-behind naloxone, field-based buprenorphine initiation, and HIV and hepatitis C virus (HCV) testing for first responder programs. Methods: Our team completed semi-structured, qualitative interviews with 32 first responders, mobile integrated health staff, and emergency medical services (EMS) leaders in King County, Washington, from February-May 2022. Semi-structured interviews were recorded, transcribed, and coded using an integrated deductive and inductive thematic analysis approach grounded in community-engaged research principles. We collected data until saturation was achieved. Data collection and analysis were informed by the Consolidated Framework for Implementation Research. Two investigators coded independently until 100% consensus was reached. Results: Our thematic analysis revealed several perceived facilitators (ie, tension for change, relative advantage, and compatibility) and barriers (ie, limited adaptability, lack of evidence strength and quality, and prohibitive cost) to the adoption of these evidence-based clinical interventions for first responder systems. There was widespread support for the distribution of leave-behind naloxone, although funding was identified as a barrier. Many believed field-based initiation of buprenorphine treatment could provide a more effective response to overdose management, but there were significant concerns that this intervention could run counter to the rapid care model. Lastly, participants worried that HIV and HCV testing was inappropriate for first responders to conduct but recommended that this service be provided by mobile integrated health staff. Conclusion: These results have informed local EMS strategic planning, which will inform roll out of process improvements in King County, Washington. Future work should evaluate the impact of these interventions on the health of overdose survivors.
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Socorristas , Reducción del Daño , Naloxona , Antagonistas de Narcóticos , Sobredosis de Opiáceos , Humanos , Sobredosis de Opiáceos/tratamiento farmacológico , Naloxona/uso terapéutico , Washingtón , Antagonistas de Narcóticos/uso terapéutico , Socorristas/psicología , Masculino , Femenino , Investigación Cualitativa , Buprenorfina/uso terapéutico , Entrevistas como Asunto , Adulto , Servicios Médicos de Urgencia , Trastornos Relacionados con Opioides/tratamiento farmacológico , Sobredosis de Droga/prevención & control , Sobredosis de Droga/tratamiento farmacológico , Persona de Mediana EdadRESUMEN
PURPOSE: This qualitative narrative synthesis sought to identify pathways connecting socioeconomic marginalization (SEM) and overdose for people who use drugs. METHODS: We included studies with qualitative examination of SEM and fatal and non-fatal overdose published in English between 2000 and 2021. Studies were systematically identified and screened by searching MEDLINE (Ovid), Embase (Ovid), PsycINFO (EBSCOhost), CINAHL (EBSCOhost), Google Scholar, Cochrane Central Registry of Controlled Trials (CENTRAL), and Cochrane Drug and Alcohol Group (CDAG) Specialized Registry, citations, and contacting experts. Risk of bias and quality assessments were performed using the Critical Appraisal Skills Programme checklist and the Confidence in the Evidence from Reviews of Qualitative Research approach. Data were synthesized using a thematic synthesis approach. RESULTS: The primary search strategy found 5909 articles that met the initial screening criteria. The review and screening process led to a final dataset of 27 qualitative articles. The four key findings of this narrative synthesis revealed aspects of SEM which shaped drug poisoning risk for people who use drugs: (1) resource insufficiency, labor market exclusion and deindustrialization, (2) homelessness and housing, (3) policing, criminalization, and interactions with emergency services, and (4) gendered and racialized dimensions of inequality. Findings led to creating a typology that includes material, behavioral, psychological, social, and environmental pathways that contain multiple mechanisms connecting SEM to overdose. This review revealed reciprocal connections between overdose and SEM via institutional pathways with reinforcing mechanisms, and interrelationships present within and between pathways. Quality assessments indicated moderate confidence in three of four findings (Findings 2,3, and 4 above) and high confidence in one finding (Finding 1). CONCLUSION: SEM is strongly linked to drug poisoning, and the mechanisms establishing these connections can be classified within four pathways. The interconnectedness of these mechanisms can lead to intensification of overdose risk and reinforcement of SEM itself.
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Sobredosis de Droga , Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos , Humanos , Factores Socioeconómicos , Investigación CualitativaRESUMEN
BACKGROUND: As Supervised Consumption Sites (SCS) are implemented in the United States, it is important to consider the needs and perceptions of impacted stakeholders. Emergency service providers (ESP) have a central role in responding to the overdose epidemic. This study intended to assess the how ESP perceive the potential implementation of an SCS in their community, as well as solicit program design and implementation-related concerns and suggestions. METHODS: In-depth interviews were conducted by videoconference with 22 ESP, including firefighters, paramedics, police, and social workers in King County, Washington, USA. Data were analyzed using a thematic analysis approach. RESULTS: Participants expressed the importance of feeling safe while responding to calls where drug use is involved and highlighted how this perception would be linked to ESP response times to calls from an SCS. Suggestions for improving the perceived safety of an SCS included training program staff in de-escalation as well as planning the layout of the SCS to accommodate ESP. The inadequacy of the emergency department as a point of care for PWUD was also identified as a theme, and some participants expressed enthusiasm regarding the prospect of the SCS as an alternative destination for transport. Finally, support for the SCS model was conditional on the appropriate utilization of emergency services and a reduction in call volume. Participants listed clarifying roles and pursuing opportunities for collaboration as ways to ensure appropriate utilization and maintain positive working relationships. CONCLUSION: This study builds on literature regarding stakeholder perceptions of SCS by focusing on the perceptions of a critically important stakeholder group. Results enhance understanding of what motivates ESP to support SCS implementation in their community. Other novel insights pertain to ESP thoughts about alternative care delivery models and strategies for emergency department visit diversion.
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Sobredosis de Droga , Servicios Médicos de Urgencia , Trastornos Relacionados con Sustancias , Humanos , Sobredosis de Droga/epidemiología , Policia , Atención a la SaludRESUMEN
BACKGROUND: Poverty and socioeconomic disadvantage are important contributors to drug-related harm, but their precise role in overdose risk remains poorly understood. We sought to examine linkages between socioeconomic marginalization and non-fatal overdose risk in a community deeply affected by the ongoing drug poisoning crisis. METHODS: This observational study used data derived from two community-recruited prospective cohorts of people who use drugs (PWUD) in Vancouver, British Columbia, Canada. Generalized linear mixed-effects models were used to assess longitudinal associations between multiple dimensions of socioeconomic disadvantage and self-reported non-fatal overdose. RESULTS: Between 2014 and 2020, 1,493 participants (38.2% women; 59.6% white; 35.7% Indigenous) provided 9,968 interviews. Non-fatal overdose was reported by 32.5% of participants over the study period. In multivariable analyses, non-fatal overdose was independently associated with incarceration (adjusted odds ratios [AOR]: 1.42, 95% confidence interval [CI]: 1.08-1.88, p=0.012), homelessness (AOR: 1.57, 95%CI: 1.27-1.93, p<0.001), increased monthly income (AOR: 1.01, 95%CI: 1.00-1.01, p=0.029), and lower material security (AOR: 0.76, 95%CI: 0.67-0.88, p<0.001). We also observed differing strengths of association between illegal income generation and overdose in men (AOR: 1.84, 95%CI: 1.46-2.32, p<0.001) compared to women (AOR: 1.37, 95%CI: 1.06-1.78, p=0.016). CONCLUSION: Non-fatal overdose was positively associated with incarceration, homelessness, higher monthly income, material insecurity, and engagement illegal income generating activities, underscoring the importance of addressing the socioeconomic production of overdose risk. These initiatives may include supportive housing interventions, alternative economic supports, and broader drug policy reform.
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Sobredosis de Droga , Masculino , Humanos , Femenino , Estudios Prospectivos , Sobredosis de Droga/epidemiología , Colombia Británica/epidemiología , Canadá , Estudios Longitudinales , Factores SocioeconómicosRESUMEN
INTRODUCTION: Methamphetamine use is on the rise with increasing emergency department (ED) visits, behavioral health crises, and deaths associated with use and overdose. Emergency clinicians describe methamphetamine use as a significant problem with high resource utilization and violence against staff, but little is known about the patient's perspective. In this study our objective was to identify the motivations for initiation and continued methamphetamine use among people who use methamphetamine and their experiences in the ED to guide future ED-based approaches. METHODS: This was a qualitative study of adults residing in the state of Washington in 2020, who used methamphetamine in the prior 30 days, met criteria for moderate- to high-risk use, reported recently receiving care in the ED, and had phone access. Twenty individuals were recruited to complete a brief survey and semi-structured interview, which was recorded and transcribed prior to being coded. Modified grounded theory guided the analysis, and the interview guide and codebook were iteratively refined. Three investigators coded the interviews until consensus was reached. Data was collected until thematic saturation. RESULTS: Participants described a shifting line that separates the positive attributes from the negative consequences of using methamphetamine. Many initially used methamphetamine to enhance social interactions, combat boredom, and escape difficult circumstances by numbing the senses. However, continued use regularly led to isolation, ED visits for the medical and psychological sequelae of methamphetamine use, and engagement in increasingly risky behaviors. Because of their overwhelmingly frustrating experiences in the past, interviewees anticipated difficult interactions with healthcare clinicians, leading to combativeness in the ED, avoidance of the ED at all costs, and downstream medical complications. Participants desired a non-judgmental conversation and linkage to outpatient social resources and addiction treatment. CONCLUSION: Methamphetamine use can lead patients to seek care in the ED, where they often feel stigmatized and are provided little assistance. Emergency clinicians should acknowledge addiction as a chronic condition, address acute medical and psychiatric symptoms adequately, and provide positive connections to addiction and medical resources. Future work should incorporate the perspectives of people who use methamphetamine into ED-based programs and interventions.
Asunto(s)
Metanfetamina , Adulto , Humanos , Metanfetamina/efectos adversos , Motivación , Servicio de Urgencia en Hospital , Investigación Cualitativa , ViolenciaRESUMEN
BACKGROUND: Children who are exposed to parental substance use disorder (SUD) have a higher risk of SUD themselves. This study examines the extent to which the association between parental and own SUD is conditional upon childhood trauma, socioeconomic status, and gender. METHODS: This study uses data from the Nashville Stress and Health Study with 1234 respondents ages 25-65 collected from 2011 to 2014, weighted be representative of the general population. The association between parental SUD and own SUD was estimated using Cox Proportional Hazard Models, controlling for covariates, and testing for interactions. RESULTS: Other things being equal, the risk of own SUD is more strongly associated with parental SUD in households with childhood traumas among men, but not women. Childhood trauma is not associated with own SUD in the absence of parental SUD among men. For men with parental SUD exposure, just one traumatic event is associated with a 38% increased risk of own SUD (HR=1.382, SE=.201, p < 0.05). For men, living with grandparents is associated with added SUD risk (HR=1.476, SE=.228, p < 0.05). For women, childhood trauma is not associated with own SUD, but parental SUD (HR=1.556, SE=.238, p < 0.01), and early onset mood or anxiety disorder (HR=1.682, SE=.316, p < 0.01) are. For both genders, those who are African American have lower risk of SUD than those who are White (HR=0.774, SE=.109, p < 0.05 for women; HR=0.672, SE=.079, p < 0.01 for men). CONCLUSIONS: Parental SUD is associated with a substantial increase in risk for own SUD, and this association differs by gender and early trauma.