Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 1.840
Filtrar
1.
J Affect Disord ; 296: 514-521, 2022 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-34656039

RESUMO

OBJECTIVE: To compare the mortality risk due to covid-19 with death due to overdose in British Columbia, Canada. The opioid epidemic was declared a public health emergency in 2016. METHODS: Mortality risk was calculated in micromorts with covid-19 data for January-October 2020, derived from the BC center for Disease Control, and illicit drug toxicity deaths for January 2010-September 2020, derived from the BC Coroners Service. Age-stratified covid-19 incidence and deaths per 100,000 population and age-stratified illicit drug toxicity death rates per 100,000 population were calculated. A micromort is a unit of risk equivalent to a one-in-a-million chance of death. RESULTS: During the covid-19 pandemic, illicit drug toxicity deaths reached 1.0 micromorts per day, representing an increase of 0.5 micromorts per day relative to 2019 rates. In comparison, covid-19 mortality risk was 0.05 micromorts per day among individuals from the general population living in British Columbia and 21.1 micromorts per day among those infected with covid-19. Covid-related mortality risk was significantly lower among individuals aged <60 years, relative to older adults, whereas drug toxicity-related mortality was highest for individuals aged 30-59 years. CONCLUSIONS: The mortality associated with covid-19 is apparent and distributed unevenly across subpopulations. The mortality due to overdose has increased during covid-19 and exceeds mortality due to covid-19. Our results instantiate the triple threat caused by covid-19 (i.e., public health crisis, economic crisis and mental health crisis) and quantitatively highlight the externality of increased mortality due to deaths of despair in response to public health efforts to reduce covid-related mortality.


Assuntos
COVID-19 , Overdose de Drogas , Idoso , Colúmbia Britânica/epidemiologia , Overdose de Drogas/epidemiologia , Humanos , Pandemias , SARS-CoV-2
2.
Public Health Rep ; 136(1_suppl): 72S-79S, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34726974

RESUMO

OBJECTIVE: Traditional public health surveillance of nonfatal opioid overdose relies on emergency department (ED) billing data, which can be delayed substantially. We compared the timeliness of 2 new data sources for rapid drug overdose surveillance-emergency medical services (EMS) and syndromic surveillance-with ED billing data. METHODS: We used data on nonfatal opioid overdoses in Kentucky captured in EMS, syndromic surveillance, and ED billing systems during 2018-2019. We evaluated the time-series relationships between EMS and ED billing data and syndromic surveillance and ED billing data by calculating cross-correlation functions, controlling for influences of autocorrelations. A case example demonstrates the usefulness of EMS and syndromic surveillance data to monitor rapid changes in opioid overdose encounters in Kentucky during the COVID-19 epidemic. RESULTS: EMS and syndromic surveillance data showed moderate-to-strong correlation with ED billing data on a lag of 0 (r = 0.694; 95% CI, 0.579-0.782; t = 9.73; df = 101; P < .001; and r = 0.656; 95% CI, 0.530-0.754; t = 8.73; df = 101; P < .001; respectively) at the week-aggregated level. After the COVID-19 emergency declaration, EMS and syndromic surveillance time series had steep increases in April and May 2020, followed by declines from June through September 2020. The ED billing data were available for analysis 3 months after the end of a calendar quarter but closely followed the trends identified by the EMS and syndromic surveillance data. CONCLUSION: Data from EMS and syndromic surveillance systems can be reliably used to monitor nonfatal opioid overdose trends in Kentucky in near-real time to inform timely public health response.


Assuntos
Analgésicos Opioides/envenenamento , Overdose de Drogas/epidemiologia , Serviços Médicos de Emergência/estatística & dados numéricos , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Vigilância da População/métodos , Vigilância em Saúde Pública/métodos , Vigilância de Evento Sentinela , Analgésicos Opioides/administração & dosagem , COVID-19/epidemiologia , Overdose de Drogas/prevenção & controle , Emergências/epidemiologia , Serviços Médicos de Emergência/tendências , Humanos , Kentucky/epidemiologia , Pandemias , Saúde Pública , SARS-CoV-2
3.
BMC Health Serv Res ; 21(1): 1279, 2021 Nov 27.
Artigo em Inglês | MEDLINE | ID: mdl-34838019

RESUMO

BACKGROUND: Peer workers (those with lived/living experience of substance use working in overdose response settings) are at the forefront of overdose response initiatives in British Columbia (BC). Working in these settings can be stressful, with lasting social, mental and emotional impacts. Peer workers have also been disproportionately burdened by the current dual public health crises characterized by the onset of the COVID-19 pandemic and rise in illicit drug overdose deaths. It is therefore critical to develop supports tailored specifically to their realities. METHODS: We used the six steps outlined in the Intervention Mapping (IM) framework to identify needs of peer workers and design an intervention model to support peer workers in overdose response settings. RESULTS: Eight peer-led focus groups were conducted in community settings to identify peer workers' needs and transcripts were analyzed using interpretive description. The strategies within the intervention model were informed by organizational development theory as well as by lived/living experience of peer workers. The support needs identified by peer workers were categorized into three key themes and these formed the basis of an intervention model titled 'ROSE'; R stands for Recognition of peer work, O for Organizational support, S for Skill development and E for Everyone. The ROSE model aims to facilitate cultural changes within organizations, leading towards more equitable and just workplaces for peer workers. This, in turn, has the potential for positive socio-ecological impact. CONCLUSIONS: Centering lived/living experience in the intervention mapping process led us to develop a framework for supporting peer workers in BC. The ROSE model can be used as a baseline for other organizations employing peer workers.


Assuntos
COVID-19 , Overdose de Drogas , Transtornos Relacionados ao Uso de Substâncias , Overdose de Drogas/epidemiologia , Overdose de Drogas/prevenção & controle , Humanos , Pandemias , Grupo Associado , SARS-CoV-2 , Transtornos Relacionados ao Uso de Substâncias/epidemiologia
5.
Subst Abuse Treat Prev Policy ; 16(1): 79, 2021 10 18.
Artigo em Inglês | MEDLINE | ID: mdl-34663374

RESUMO

BACKGROUND: British Columbia (BC) is in the midst of an opioid overdose crisis. Since 2017, smoking illicit drugs has been the leading mode of drug administration causing overdose death. Yet, little is known about people who smoke opioids, and factors underlying choice of mode of administration. The study objectives are to identify the prevalence and correlates associated with smoking opioids. METHODS: The Harm Reduction Client Survey is a monitoring tool used by the BC Centre for Disease Control since 2012. This survey is disseminated to harm reduction sites across BC to understand drug use trends and drug-related harms. We examined data from the survey administered October-December 2019 and performed descriptive, univariate, and multivariate analyses to better understand factors associated with smoking opioids. RESULTS: A total of 369 people who used opioids in the past 3 days were included, of whom 251 (68.0%) reported smoking opioids. A total of 109 (29.5%) respondents experienced an overdose in the past 6 months; of these 79 (72.5%) smoked opioids. Factors significantly associated with smoking opioids were: living in a small community (AOR =2.41, CI =1.27-4.58), being a woman (AOR = 1.84, CI = 1.03-3.30), age under 30 (AOR = 5.41, CI = 2.19-13.40) or 30-39 (AOR = 2.77, CI = 1.33-5.78) compared to age ≥ 50, using drugs alone (AOR = 2.98, CI = 1.30-6.83), and owning a take-home naloxone kit (AOR = 2.01, CI = 1.08-3.72). Reported use of methamphetamines within the past 3 days was strongly associated with smoking opioids (AOR = 6.48, CI = 3.51-11.96). CONCLUSIONS: Our findings highlight important correlates associated with smoking opioids, particularly the recent use of methamphetamines. These findings identify actions to better respond to the overdose crisis, such as targeted harm reduction approaches, educating on safer smoking, advocating for consumption sites where people can smoke drugs, and providing a regulated supply of opioids that can be smoked.


Assuntos
Analgésicos Opioides , Overdose de Drogas , Analgésicos Opioides/uso terapêutico , Colúmbia Britânica/epidemiologia , Overdose de Drogas/tratamento farmacológico , Overdose de Drogas/epidemiologia , Feminino , Humanos , Prevalência , Fumaça , Fumar/epidemiologia
6.
Drug Alcohol Depend ; 228: 108977, 2021 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-34598100

RESUMO

BACKGROUND: Although national syndromic surveillance data reported declines in emergency department (ED) visits after the declaration of the national stay-at-home order for COVID-19, little is known whether these declines were observed for suspected opioid overdose. METHODS: This interrupted time series study used syndromic surveillance data from four states participating in the HEALing Communities Study: Kentucky, Massachusetts, New York, and Ohio. All ED encounters for suspected opioid overdose (n = 48,301) occurring during the first 31 weeks of 2020 were included. We examined the impact of the national public health emergency for COVID-19 (declared on March 14, 2020) on trends in ED encounters for suspected opioid overdose. RESULTS: Three of four states (Massachusetts, New York and Ohio) experienced a statistically significant immediate decline in the rate of ED encounters for suspected opioid overdose (per 100,000) after the nationwide public health emergency declaration (MA: -0.99; 95 % CI: -1.75, -0.24; NY: -0.10; 95 % CI, -0.20, 0.0; OH: -0.33, 95 % CI: -0.58, -0.07). After this date, Ohio and Kentucky experienced a sustained rate of increase for a 13-week period. New York experienced a decrease in the rate of ED encounters for a 10-week period, after which the rate began to increase. In Massachusetts after a significant immediate decline in the rate of ED encounters, there was no significant difference in the rate of change for a 6-week period, followed by an immediate increase in the ED rate to higher than pre-COVID levels. CONCLUSIONS: The heterogeneity in the trends in ED encounters between the four sites show that the national stay-at-home order had a differential impact on opioid overdose ED presentation in each state.


Assuntos
COVID-19 , Overdose de Drogas , Overdose de Opiáceos , Analgésicos Opioides , Overdose de Drogas/epidemiologia , Serviço Hospitalar de Emergência , Humanos , Pandemias , SARS-CoV-2
7.
J Opioid Manag ; 17(5): 363-382, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34714537

RESUMO

BACKGROUND: The opioid crisis has been increasing in severity over the past several decades. Every year, thousands of people die due to opioid-related issues. The factors that play into the causes of this are complex. Our study aimed to see how commute times, city budget for roads, and city budget for arts and culture contribute to the city's overall opioid death rates. We know that overdose rates are more common in cities rather than rural areas, therefore making one major city per state as part of our design. METHODS: We collected data from one city per state (n = 50) and ran two ANOVA tests and 11 logistical regression tests. Both types of tests were run on IBM SPSS Statistical software version 25 at its default settings with a confidence interval set to 95 percent. Opioid deaths were the dependent variable, whereas commute time, budget for roads, and budget for arts and culture were the independent variables. RESULTS: Commute time yielded a significant result in almost all the tests it was included in: Table 1, 0.033; Table 3, 0.000; Figure 4, 0.000; Figure 5, 0.000. Budget for roads also showed significant results in most of its tests as well: Table 1, 0.003; Table 2, 0.047; Figure 3, 0.001. Budget for arts and culture showed significant results but not in a pattern that we could interpret: Table 1, 0.002; Table 2, 0.021; Table 4, 0.013. CONCLUSIONS: Commute time and the budget for roads are likely to play a role in their city's opioid crisis. Understanding where a city fits in relation to these results may better help them prepare and reduce opioid death rates.


Assuntos
Analgésicos Opioides , Overdose de Drogas , Analgésicos Opioides/efeitos adversos , Cidades , Overdose de Drogas/epidemiologia , Humanos , Epidemia de Opioides , Fatores Socioeconômicos
8.
Asian J Psychiatr ; 65: 102826, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34500391

RESUMO

BACKGROUND: Limited information is currently available on drug overdose in Japan. Therefore, the present study examined drug overdose using the Japanese Adverse Drug Event Report (JADER) database. METHODS: The records of drug overdose in patients were extracted from the JADER database. Risk factors for drug overdose in patients with bipolar disorders were examined using a multiple logistic regression analysis. RESULTS: Overdoses of 1327 medicines in 784 patients were registered in the JADER database. An overdose of lithium carbonate was the most frequently reported in 144 patients, followed by zolpidem tartrate in 88, and then quetiapine fumarate, sodium valproate, risperidone, and paroxetine hydrochloride hydrate. The number of overdoses was higher in females, and peaked in patients aged with 30-39 years. The dosages of overdosed lithium carbonate ranged between 1800 and 60,000 mg, with a median of 8400 mg, while those of overdosed zolpidem tartrate ranged between 15 and 600 mg, with a median of 105 mg. Forty-one drug overdose cases were registered in 3521 patients with bipolar disorder, bipolar I disorder, or bipolar II disorder in the JADER database. A multivariate analysis of these cases identified female sex, an age younger than 50 years, and the use of lithium carbonate as risk factors for drug overdose. Lamotrigine reduced its odds, and no relationship was observed with aripiprazole or sodium valproate. CONCLUSION: The present study represented a surveillance of drug overdose, and identified risk factors in patients with bipolar disorders by a multivariate analysis using the JADER database.


Assuntos
Overdose de Drogas , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Sistemas de Notificação de Reações Adversas a Medicamentos , Idoso , Overdose de Drogas/epidemiologia , Feminino , Humanos , Japão/epidemiologia , Pessoa de Meia-Idade , Análise Multivariada , Fatores de Risco
9.
Lakartidningen ; 1182021 09 30.
Artigo em Sueco | MEDLINE | ID: mdl-34590703

RESUMO

Overdoses with the sedating antihistamines alimemazine, hydroxyzine, promethazine and propiomazine have received attention in recent years in Sweden. The Poisons Information Center has noted an increase in calls regarding intoxications, and the National Board of Forensic Medicine has concluded that these substances have directly contributed to a large number of poisoning deaths. When prescribing alimemazine, hydroxyzine, promethazine and propiomazine, their pharmacological properties, such as antihistaminergic and anticholinergic effects, and their anti-arrhythmic potential must be considered. Furthermore, it is important to also consider the risks of severe intoxication in case of overdose. The lowest possible amount should be prescribed. Special attention is required when prescribing alimemazine oral solution.


Assuntos
Overdose de Drogas , Antagonistas dos Receptores Histamínicos H1 , Antagonistas Colinérgicos/efeitos adversos , Overdose de Drogas/epidemiologia , Humanos , Prometazina , Suécia/epidemiologia
10.
JAMA Netw Open ; 4(9): e2125538, 2021 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-34533569

RESUMO

Importance: The rate of deaths from overdose has increased during the COVID-19 pandemic, and recent US overdose mortality rates have been markedly high. However, scant data are available on the causes of this increase or subpopulations at elevated risk. Objective: To evaluate the rates and characteristics of deaths from drug overdose before vs during the COVID-19 pandemic. Design, Setting, and Participants: This retrospective, population-based cohort study used data from 4 statewide databases linked at the person level via the Rhode Island Data Ecosystem on adults with deaths due to overdose in Rhode Island from January 1 to August 31, 2019, and January 1 to August 31, 2020. Main Outcomes and Measures: The rates of unintentional deaths from drug-related overdose during the 2019 and 2020 observation periods overall and by sociodemographic characteristics, drugs contributing to the cause of death, location of death, and socioeconomic factors were evaluated. In subgroup analyses restricted to Medicaid beneficiaries (n = 271), the proportions of deaths from overdose by behavioral health treatment and diagnosis claims in the year before death were also examined. Results: A total of 470 adults who died of drug overdose were included in the analysis (353 men [75%]; mean [SD] age, 43.5 [12.1] years). The rate of deaths from overdose in Rhode Island increased 28.1%, from 29.2 per 100 000 person-years in 2019 to 37.4 per 100 000 person-years in 2020 (P = .009). Compared with 2019, rates of deaths due to overdose during 2020 were higher among men (43.2 vs 59.2 per 100 000 person-years; P = .003), non-Hispanic White individuals (31.0 vs 42.0 per 100 000 person-years; P = .005), single individuals (54.8 vs 70.4 per 100 000 person-years; P = .04), deaths involving synthetic opioids (20.8 vs 28.3 per 100 000 person-years; P = .005), and deaths occurring in a personal residence (13.2 vs 19.7 per 100 000 person-years; P = .003). A decrease in the proportion of deaths from overdose involving heroin (11 of 206 [5%] vs <2% [exact value suppressed]; P = .02) and an increase among persons experiencing job loss (16 of 206 [8%] vs 41 of 264 [16%]; P = .01) from 2019 to 2020 were observed. Among individuals who died of overdose and were Medicaid beneficiaries, the proportions of those aged 50 to 59 years with anxiety (11 of 121 [9%] vs 29 of 150 [19%]; P = .03), men with depression (27 of 121 [22%] vs 57 of 150 [38%]; P = .008), and men with anxiety (28 of 121 [23%] vs 55 of 150 [37%]; P = .02) increased during 2020 compared with 2019. Conclusions and Relevance: In this cohort study, during the first 8 months of 2020, the rate of deaths from overdose increased in Rhode Island compared with the same period in 2019, and several emerging characteristics of deaths from drug overdose during the first year of the COVID-19 pandemic were identified. These findings may inform interventions that address macroenvironmental changes associated with the pandemic.


Assuntos
COVID-19 , Overdose de Drogas/mortalidade , Adulto , Estudos de Coortes , Overdose de Drogas/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Quarentena/psicologia , Quarentena/estatística & dados numéricos , Estudos Retrospectivos , Rhode Island/epidemiologia
12.
CMAJ Open ; 9(3): E907-E914, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34584005

RESUMO

BACKGROUND: People recently released from prison are at increased risk of preventable death; however, the impact of the current overdose epidemic on this population is unknown. We aimed to document the incidence and identify risk factors for fatal overdose after release from provincial prisons in British Columbia. METHODS: We conducted a retrospective, population-based, open cohort study of adults released from prisons in BC, using linked administrative data. Within a random 20% sample of the BC population, we linked provincial health and correctional records from 2010 to 2017 for people aged 23 years or older as of Jan. 1, 2015, who were released from provincial prisons at least once from 2015 to 2017. We identified exposures that occurred from 2010 to 2017 and deaths from 2015 to 2017. We calculated the piecewise incidence of overdose-related and all-cause deaths after release from prison. We used multivariable, mixed-effects Cox regression to identify predictors of all-cause death and death from overdose. RESULTS: Among 6106 adults released from prison from 2015 to 2017 and followed in the community for a median of 1.6 (interquartile range 0.9-2.3) years, 154 (2.5%) died, 108 (1.8%) from overdose. The incidence of all-cause death was 16.1 (95% confidence interval [CI] 13.7-18.8) per 1000 person-years. The incidence of overdose deaths was 11.2 (95% CI 9.2-13.5) per 1000 person-years, but 38.8 (95% CI 3.2-22.6) in the first 2 weeks after release from prison. After adjustment for covariates, the hazard of overdose death was 4 times higher among those who had been dispensed opioids for pain. INTERPRETATION: People released from prisons in BC are at markedly increased risk of overdose death. Overdose prevention must go beyond provision of opioid agonist treatment and naloxone on release to address systemic social and health inequities that increase the risk of premature death.


Assuntos
Overdose de Drogas/epidemiologia , Antagonistas de Entorpecentes/uso terapêutico , Overdose de Opiáceos , Serviços Preventivos de Saúde , Prisioneiros/estatística & dados numéricos , Adulto , Colúmbia Britânica , Causas de Morte , Feminino , Humanos , Incidência , Armazenamento e Recuperação da Informação/estatística & dados numéricos , Masculino , Naloxona/uso terapêutico , Determinação de Necessidades de Cuidados de Saúde , Overdose de Opiáceos/mortalidade , Overdose de Opiáceos/prevenção & controle , Serviços Preventivos de Saúde/métodos , Serviços Preventivos de Saúde/organização & administração , Estudos Retrospectivos , Fatores de Risco
13.
Subst Abuse Treat Prev Policy ; 16(1): 73, 2021 09 26.
Artigo em Inglês | MEDLINE | ID: mdl-34565405

RESUMO

BACKGROUND: Opioid overdose (OD) and opioid OD death are major health threats to people with opioid use disorder (OUD). Socioeconomic factors are underexplored potential determinants of opioid OD. In this study, we assessed socioeconomic and other factors and their associations with incident and fatal opioid OD, in a cohort consisting of 22,079 individuals with OUD. METHODS: We performed a retrospective, longitudinal study based on Swedish national register data for the period January 2005-December 2017. We used Cox proportional hazard models to investigate the risk of incident and fatal opioid OD as a function of several individual, parental and neighborhood covariates. RESULTS: Univariate analysis showed that several covariates were associated with incident and fatal opioid OD. In the multivariate analysis, incident opioid OD was associated with educational attainment (Hazard ratio [HR] 0.96; 95% confidence interval [CI] 0.94-0.97), having received social welfare (HR 1.31; 95% CI 1.22-1.39), and criminal conviction (HR 1.53; 95% CI 1.42-1.65). Fatal opioid OD was also associated with criminal conviction (HR 1.93; 95% CI 1.61-2.32). CONCLUSION: Individuals with low education and receipt of social welfare had higher risks of incident opioid OD and individuals with criminal conviction were identified as a risk group for both incident and fatal opioid OD. Our findings should raise attention among health prevention policy makers in general, and among decision-makers within the criminal justice system and social services in particular.


Assuntos
Overdose de Drogas , Overdose de Opiáceos , Transtornos Relacionados ao Uso de Opioides , Analgésicos Opioides/efeitos adversos , Overdose de Drogas/tratamento farmacológico , Overdose de Drogas/epidemiologia , Humanos , Estudos Longitudinais , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Estudos Retrospectivos , Fatores Socioeconômicos , Suécia/epidemiologia
14.
Drug Alcohol Depend ; 228: 109028, 2021 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-34500239

RESUMO

BACKGROUND: Opioid-related morbidity and mortality has increased during the COVID-19 pandemic, yet specific information about the communities most affected remains unknown. Our objective is to evaluate decedent-level associations with an opioid-related death following the implementation of stay-at-home orders in Los Angeles County. METHODS: This retrospective cohort study used data from the L.A. County Medical Examiner-Coroner to identify opioid-related deaths in 2019 and 2020. We used logistic regression to analyze the change in opioid-related deaths following a 30-day washout period after the start of stay-at-home orders. Independent variables included decedent age, gender, race and ethnicity, heroin or fentanyl present at the time of death, census tract-level education, and a scheduled drug prescription in the year before death. RESULTS: Opioid-related deaths in L.A. County are most common in census tracts where a small percentage of the population has a Bachelor's degree. Following stay-at-home orders, Non-Hispanic Caucasian individuals had significantly more opioid-related deaths than Hispanic individuals (risk ratio (RR): 1.82 [95 % CI, 1.10-3.02]; P < 0.05) after adjusting for age, gender, and heroin or fentanyl use. Racial and ethnic differences in mortality were not explained by census tract-level education or recent scheduled drug prescriptions. DISCUSSION: There has been an alarming rise in opioid-related deaths in L.A. County during 2020. The increase in opioid-related overdose deaths following the onset of COVID-19 and related policies occurred most often among Non-Hispanic Caucasian individuals. Further research on this trend's underlying cause is needed to inform policy recommendations during these simultaneous public health crises.


Assuntos
COVID-19 , Overdose de Drogas , Analgésicos Opioides/uso terapêutico , Overdose de Drogas/epidemiologia , Humanos , Los Angeles/epidemiologia , Pandemias , Estudos Retrospectivos , SARS-CoV-2
16.
Drug Alcohol Depend ; 227: 109012, 2021 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-34482035

RESUMO

BACKGROUND: The opioid crisis in the United States continues to worsen. Several states have passed laws granting pharmacists the authority to independently prescribe (not just dispense) naloxone. Since pharmacists are accessible healthcare providers, enhancing their ability to prescribe naloxone, an effective opioid overdose reversal agent, may help combat the ongoing opioid overdose epidemic. METHOD: Using a nationally representative database on drug dispensing in 2010 to 2018 from Symphony Health, we conducted a cross-sectional study to assess whether state laws authorizing pharmacists to prescribe naloxone were associated with increased naloxone dispensing from retail pharmacies. RESULTS: The number of naloxone prescriptions dispensed from retail pharmacies increased from 2010 to 2018 and doubled from 2017 to 2018. The presence of state laws authorizing pharmacists to prescribe naloxone is associated with an average increase of 331(95% CI = 43.56, 618.49) prescription dispensed per state per quarter. This represents an approximately 53% increase in naloxone dispensed compared to pharmacies in states where there were no such laws. CONCLUSIONS: Our study suggests that state laws that allow pharmacists to prescribe and not just dispense naloxone at retail pharmacies can increase the availability and accessibility of naloxone. Adopting and implementing such laws may help reduce serious and life-threatening opioid overdoses.


Assuntos
Overdose de Drogas , Transtornos Relacionados ao Uso de Opioides , Farmácias , Estudos Transversais , Overdose de Drogas/tratamento farmacológico , Overdose de Drogas/epidemiologia , Overdose de Drogas/prevenção & controle , Humanos , Naloxona/uso terapêutico , Antagonistas de Entorpecentes/uso terapêutico , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Farmacêuticos , Estados Unidos
17.
Drug Alcohol Depend ; 227: 108994, 2021 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-34482038

RESUMO

INTRO: Understanding sex differences in toxicological etiologies of opioid-related drug overdose death could inform future sex- and gender-specific approaches to prevention and treatment. METHODS: A retrospective review of accidental or undetermined opioid-involved overdose deaths in Rhode Island 2016-2019 was performed using the Rhode Island Department of Health State Unintentional Drug Overdose Reporting System (SUDORS) database. Decedent toxicology data was linked with state Prescription Drug Monitoring Program (PDMP) records. RESULTS: Of 766 cases in the analytical sample, 568 cases were in men (74.2%) and 198 cases were in women (25.6%). Median age was 40.0 years for males and 42.0 years for females. Statistically significant sex-differences in drug exposures were found. Compared to men, women were more likely have exposure to benzodiazepine, antipsychotic, and antidepressant drug classes and less likely to have fentanyl and alcohol co-exposure. No sex differences were found in cocaine and amphetamine exposure. Female decedents were more likely than male decedents to have a prescription for benzodiazepines or opioids in the 30 days before death (40% vs 21%). The proportion of decedents with a benzodiazepine on post-mortem toxicology testing in combination with a benzodiazepine prescription (p < 0.001) or an opioid prescription (p = 0.005) was over two times higher in women than men. CONCLUSION: Higher rates of controlled substance prescription prior to death and prescription drug co-exposures suggest that female opioid-involved drug overdose decedents are often in contact with the health care system immediately preceding their death, presenting the opportunity to create patient-centric approaches for prevention, harm reduction, and substance use treatment.


Assuntos
Overdose de Drogas , Overdose de Opiáceos , Adulto , Analgésicos Opioides , Overdose de Drogas/epidemiologia , Feminino , Fentanila , Humanos , Masculino , Estudos Retrospectivos , Caracteres Sexuais
18.
Subst Use Misuse ; 56(13): 1997-2006, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34470589

RESUMO

INTRODUCTION: Heroin overdose is a leading cause of mortality among drug users. This paper aims to identify individual and contextual factors associated with lethal and non-lethal heroin-related overdoses on the basis of case reports and semi-structured proxy interviews. Typical patterns within these cases are determined by means of cluster analysis. METHODS: Within the CaRe (Case Reports of heroin-related overdoses) study, case reports (100 proxy reports of overdose events from 36 different facilities) were gathered and evaluated as part of a nationwide survey of experts conducted in Germany in 2019. Following initial descriptive analyses a two-step cluster analysis with the four binary variables of gender, age, time and place was conducted to identify patterns within the reported cases. RESULTS: The case reports grouped into five clusters: 1) Younger male drug users, found in a public space during the daytime; 2) Female drug users; 3) Older male drug users, found in a public space during the daytime; 4) Drug users found at home at night; 5) Drug users found outside at night. Overdoses by female drug users and those which occurred at home and/or at night were significantly more likely to have a fatal outcome. CONCLUSION: Future prevention and intervention measures should aim to consider the context, i.e. typical constellations of risk, and attempt to inhibit this through appropriate counter measures.


Assuntos
Overdose de Drogas , Usuários de Drogas , Dependência de Heroína , Overdose de Opiáceos , Overdose de Drogas/epidemiologia , Feminino , Heroína , Dependência de Heroína/epidemiologia , Humanos , Masculino
19.
Subst Abuse Treat Prev Policy ; 16(1): 60, 2021 08 09.
Artigo em Inglês | MEDLINE | ID: mdl-34372900

RESUMO

RESEARCH OBJECTIVE: The COVID-19 pandemic disrupted healthcare delivery worldwide with likely negative effects on people who use opioids (PWUO). This scoping review of the original research literature describes the impact of the COVID-19 pandemic on healthcare delivery for PWUO and identifies gaps in the literature. METHODS: This scoping review of the original research literature maps the available knowledge regarding the impact of the COVID-19 pandemic on healthcare delivery for PWUO. We utilized the methodology developed by the Joanna Briggs Institute for scoping reviews, and content analyses methodology to characterize the current state of the literature. RESULTS: Of the 14 included studies, administrative database (n = 11), cross-sectional (n = 1) or qualitative (n = 2) studies demonstrated service gaps (n = 7), patient/provider experiences (n = 3), and patient outcomes for PWUO (n = 4). In March 2020, healthcare utilization dropped quickly, sharply increasing only for reasons of opioid overdose by May 2020. Service gaps existed in accessing treatment for new patients during the pandemic due to capacity and infrastructure limits. Physicians reported difficulty referring patients to begin an outpatient opioid treatment program due to increased restrictions in capacity and infrastructure. Patients also reported uncertainty about accessing outpatient treatment, but that telehealth initiation of buprenorphine increased access to treatment from home. Disproportionate increases in overdose rates among African Americans were reported in two studies, with differences by race and gender not examined in most studies. Fatal overdoses increased 60% in African Americans during the pandemic, while fatal overdoses in Non-Hispanic White individuals decreased. CONCLUSIONS: In summary, this beginning evidence demonstrates that despite early reluctance to use the healthcare system, opioid overdose-related use of healthcare increased throughout the pandemic. Service delivery for medications to treat OUD remained at or above pre-pandemic levels, indicating the ability of telehealth to meet demand. Yet, racial disparities that existed pre-pandemic for PWUO are intensifying, and targeted intervention for high-risk groups is warranted to prevent further mortality. As the pandemic progresses, future research must focus on identifying and supporting subgroups of PWUO who are at heightened risk for experiencing negative outcomes and lack of access to care.


Assuntos
COVID-19/epidemiologia , Overdose de Drogas/epidemiologia , Acesso aos Serviços de Saúde/organização & administração , Transtornos Relacionados ao Uso de Opioides/terapia , Buprenorfina/uso terapêutico , Estudos Transversais , Overdose de Drogas/etnologia , Overdose de Drogas/mortalidade , Serviços Médicos de Emergência/estatística & dados numéricos , Humanos , Metadona/uso terapêutico , Antagonistas de Entorpecentes/uso terapêutico , Tratamento de Substituição de Opiáceos , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Pandemias , Satisfação do Paciente , SARS-CoV-2 , Telemedicina/organização & administração
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...