RESUMO
BACKGROUND: Stress indicators, including perceived discrimination and depression, have been linked with chronic diseases. Studies have also linked persistent prescription opioid use (PPOU) with depression. With increasing numbers of opioid overdose deaths among Hispanics (predominantly Puerto Rican) in Massachusetts, investigating how perceived discrimination and depression affect PPOU is relevant to public health efforts to address the opioid crisis. This study examined the effect of depression on PPOU and whether depression mediated the association between perceived discrimination and PPOU among Puerto Rican adults. METHODS: Data derived from a prospective population-based Boston Puerto Rican Health Study, at baseline and ~2- and ~6-year follow-up, were used to estimate the association between perceived discrimination and PPOU. Baron and Kenny's method was used to examine the potential mediating effect of depression. RESULTS: A total of 798 Puerto Rican adults (aged 56.5 ± 7.5 years, 72.9% women) participated in the study at all three time points, and 6.5% used prescription opioids persistently. Both depressive symptoms (Center for Epidemiological Studies Depression Scale score range: 0-60; OR = 1.03, 95% CI [1.00, 1.05], p = .03) and perceived discrimination (yes/no; OR = 2.43, 95% CI [1.28, 4.61], p = .006) were associated with PPOU. Depressive symptomatology partially mediated the effect of perceived discrimination on PPOU, by 10.3%. CONCLUSIONS: Among Puerto Rican adults in Massachusetts, depressive symptomatology partially explained the effects of perceived discrimination on PPOU. Other unidentified factors could play a role in the relationship between perceived discrimination and PPOU. Discussion on the potential risks of PPOU should be considered among underserved populations experiencing chronic pain, discrimination, and depressive symptoms.
Assuntos
Hispânico ou Latino , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Analgésicos Opioides/uso terapêutico , Boston/epidemiologia , Depressão/epidemiologia , Hispânico ou Latino/psicologia , Hispânico ou Latino/estatística & dados numéricos , Massachusetts/epidemiologia , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Transtornos Relacionados ao Uso de Opioides/psicologia , Estudos Prospectivos , Porto Rico/etnologiaRESUMO
In the last decade, the opioid overdose epidemic has been exacerbated by the emerging drug of abuse, xylazine. This veterinary anesthetic, an alpha-2 agonist, not only potentiates the fatal effects of opioids but also causes toxic endothelial effects. This review aims to assess the impact of xylazine use and overdoses within the context of the opioid crisis as a public health issue. The research used data from scientific publications, state health reports, and analyses from the Institute of Forensic Sciences of Puerto Rico. The databases PubMed, Google Scholar, and Scopus were searched for relevant publications. The search strategy employed two groups of terms: the drug of interest (xylazine) and types of exposure (drug use, overdose, substance abuse, etc.). The initial search in PubMed was then extrapolated, and the search terms were adjusted for appropriate database syntax. According to the most recent publications and CDC data in the USA, approximately 95 % of fentanyl overdose cases involve xylazine, while the other 5 % of overdose cases are attributed solely to xylazine, predominantly administered intravenously. In the last four years, more than 4000 overdose deaths have been related to xylazine use; the northeastern United States had reported the most significant number of deaths. This number changes daily as reanalysis results and new data are published. Less than 50 % of states perform tests for xylazine detection or maintain statistical monitoring of overdoses related to this drug. The absence of testing impedes emergency room physicians from making accurate diagnoses, increasing the likelihood of fatal overdoses. This review highlights five major concerns: (1) The recognition of intoxication as a primary concern and the unavailability of alpha-2 antagonists for treatment. (2) The challenges in the clinical setting linked to xylazine abuse and its co-administration with substances like fentanyl and its analogs. (3) The necessity for robust government statistical resources for the unification and dissemination of critical overdose and emerging drug abuse detection information. (4) The need for effective rehabilitation programs, including psychosocial support and treatment interventions, to respond to this public health crisis. (5) The urgency for further research to understand the prevalence, toxic effects of chronic or acute use, and the clinical implications in xylazine users, including the development of alpha-2 antagonists for treatment. We conclude that addressing these concerns is crucial to working with the xylazine abuse situation.
Assuntos
Overdose de Drogas , Xilazina , Humanos , Estados Unidos/epidemiologia , Overdose de Drogas/mortalidade , Overdose de Drogas/epidemiologia , Porto Rico/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/mortalidade , Agonistas de Receptores Adrenérgicos alfa 2/intoxicação , Transtornos Relacionados ao Uso de Opioides/mortalidade , Transtornos Relacionados ao Uso de Opioides/epidemiologiaRESUMO
BACKGROUND: The growing availability of big data spontaneously generated by social media platforms allows us to leverage natural language processing (NLP) methods as valuable tools to understand the opioid crisis. OBJECTIVE: We aimed to understand how NLP has been applied to Reddit (Reddit Inc) data to study opioid use. METHODS: We systematically searched for peer-reviewed studies and conference abstracts in PubMed, Scopus, PsycINFO, ACL Anthology, IEEE Xplore, and Association for Computing Machinery data repositories up to July 19, 2022. Inclusion criteria were studies investigating opioid use, using NLP techniques to analyze the textual corpora, and using Reddit as the social media data source. We were specifically interested in mapping studies' overarching goals and findings, methodologies and software used, and main limitations. RESULTS: In total, 30 studies were included, which were classified into 4 nonmutually exclusive overarching goal categories: methodological (n=6, 20% studies), infodemiology (n=22, 73% studies), infoveillance (n=7, 23% studies), and pharmacovigilance (n=3, 10% studies). NLP methods were used to identify content relevant to opioid use among vast quantities of textual data, to establish potential relationships between opioid use patterns or profiles and contextual factors or comorbidities, and to anticipate individuals' transitions between different opioid-related subreddits, likely revealing progression through opioid use stages. Most studies used an embedding technique (12/30, 40%), prediction or classification approach (12/30, 40%), topic modeling (9/30, 30%), and sentiment analysis (6/30, 20%). The most frequently used programming languages were Python (20/30, 67%) and R (2/30, 7%). Among the studies that reported limitations (20/30, 67%), the most cited was the uncertainty regarding whether redditors participating in these forums were representative of people who use opioids (8/20, 40%). The papers were very recent (28/30, 93%), from 2019 to 2022, with authors from a range of disciplines. CONCLUSIONS: This scoping review identified a wide variety of NLP techniques and applications used to support surveillance and social media interventions addressing the opioid crisis. Despite the clear potential of these methods to enable the identification of opioid-relevant content in Reddit and its analysis, there are limits to the degree of interpretive meaning that they can provide. Moreover, we identified the need for standardized ethical guidelines to govern the use of Reddit data to safeguard the anonymity and privacy of people using these forums.
Assuntos
Processamento de Linguagem Natural , Mídias Sociais , Humanos , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Analgésicos Opioides/efeitos adversos , Analgésicos Opioides/uso terapêuticoRESUMO
BACKGROUND: We assess trends in overdose mortality rates in Mexico from 1999 to 2019 and identify the states with the highest overdose mortality rates over time. METHODS: The analysis using mortality statistics examined deaths related to drug use. We estimated general overdose mortality rates at the national and state levels and calculated specific mortality rates associated with opioid and stimulant use using central rate estimation. We used joinpoint regression to analyse national and state-specific trends in overdose mortality from 1999 to 2019. FINDINGS: Nationally, the general overdose mortality rate increased annually by 10.49 % (p < 0.01, CI=11.4-18.9) from 2015 to 2019. The northern states of Baja California and Chihuahua were the states with the higher annual increases (18.6 %, p < 0.01, CI=4.2-29.6; and 15.6 %, p < 0.01, CI=12.9-19.7, respectively). By substance type, the national opioid-related mortality rate increased by 29.82 % per year from 2014 to 2019 (p < 0.01; CI=20.1-40.3), compared with an annual decrease of 11.43 % in the previous period (2005-2014) (p < 0.01; CI=-14.7- 8.0). Baja California was the state with the highest rise in opioid-related mortality from 2013 to 2019, with an annual increase of 15.84 % (p < 0.01; CI=1.4-32.3). Stimulant-related mortality increased by 21.79 % per year since 2013 (p < 0.01; CI=16.9-26.9), but it was not possible to calculate state-level trends. CONCLUSIONS: Drug-related mortality rates have increased in Mexico since 2015, particularly in the northern states of Baja California, Chihuahua, Sonora and Sinaloa. Improving harm reduction programmes and local surveillance of fatal and non-fatal overdoses is essential to address the silent escalation of overdose mortality.
Assuntos
Overdose de Drogas , Humanos , México/epidemiologia , Overdose de Drogas/mortalidade , Overdose de Drogas/epidemiologia , Transtornos Relacionados ao Uso de Opioides/mortalidade , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Adulto , Masculino , Feminino , Analgésicos Opioides/intoxicação , Transtornos Relacionados ao Uso de Substâncias/mortalidade , Transtornos Relacionados ao Uso de Substâncias/epidemiologiaRESUMO
OBJECTIVE: To develop a dyadic-centered framework focused on clinical care, surveillance, and research for birthing persons with opioid use disorder (OUD) and their infants and children. STUDY DESIGN: Between February and March 2023, an analysis was conducted within the US Department of Health and Human Services (HHS) of activities directed at opioid-exposed birthing persons and their infants and children (the dyad) to identify: 1) number of activities, stratified by type and 2) characteristics across health and supportive activities that serve the dyad vs birthing persons or infants and children individually. Descriptive and thematic analyses were used to assess quantity and characteristics of fiscal year 2023-2024 activities aggregated across eleven HHS agencies. RESULTS: Of 181 activities examined, 75 met inclusion criteria specific to serving birthing persons with OUD and opioid-exposed infants and children. Sixty-two percent of activities were dyad focused. Five categories of dyadic activities were identified: research (45%), education and training (28%), health and supportive services (21%), surveillance (4%), and quality improvement (2%). Eight specific characteristics were key to dyadic activities: a life course and generational approach, emphasis on relationship, dyadic outcomes, service wraparound, payment structures supporting dyadic care, data linkage, and social determinants of health. CONCLUSIONS: This analysis of HHS activities directed at birthing persons with OUD and opioid-exposed infants and children showed that most programs had a dyadic focus. Synthesizing elements identified from activities serving the dyad facilitated the development of a dyadic framework integrating clinical care, public health surveillance, and research.
Assuntos
Analgésicos Opioides , Transtornos Relacionados ao Uso de Opioides , Lactente , Criança , Humanos , Analgésicos Opioides/uso terapêutico , Transtornos Relacionados ao Uso de Opioides/epidemiologiaRESUMO
OBJECTIVE: While Opioid Use Disorder (OUD) has been linked to inferior clinical outcomes, studies examining the clinical outcomes and readmission of OUD patients experiencing Acute Myocardial Infarction (AMI) remain lacking. The authors analyze the clinical and financial outcomes of OUD in a contemporary cohort of AMI hospitalizations. METHODS: All non-elective adult (≥ 18 years) hospitalizations for AMI were tabulated from the 2016â2019 Nationwide Readmissions Database using relevant International Classification of Disease codes. Patients were grouped into OUD and non-OUD cohorts. Bivariate and regression analyses were performed to identify the independent association of OUD with outcomes after non-elective admission for AMI, as well as subsequent readmission. RESULTS: Of an estimated 3,318,257 hospitalizations for AMI meeting study criteria, 36,057 (1.1%) had a concomitant diagnosis of OUD. While OUD was not significantly associated with mortality, OUD patients experienced superior cardiovascular outcomes compared to non-OUD. However, OUD was linked to increased odds of non-cardiovascular complications, length of stay, costs, non-home discharge, and 30-day non-elective readmission. CONCLUSIONS: Patients with OUD presented with AMI at a significantly younger age than non-OUD. While OUD appears to have a cardioprotective effect, it is associated with several markers of increased resource use, including readmission. The present findings underscore the need for a multifaceted approach to increasing social services and treatment for OUD at index hospitalization.
Assuntos
Infarto do Miocárdio , Transtornos Relacionados ao Uso de Opioides , Adulto , Humanos , Estados Unidos/epidemiologia , Hospitalização , Infarto do Miocárdio/terapia , Readmissão do Paciente , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Transtornos Relacionados ao Uso de Opioides/terapia , Alta do Paciente , Estudos RetrospectivosRESUMO
Background: The paper explores the opinions of Nigerian youth regarding their reasons behind the use of tramadol for non-medical purposes and learns their preferences in choosing tramadol. Methods: We conducted In-depth Interviews (IDIs) and Focus Group Discussions (FGDs) among students in secondary schools, tertiary schools and out-of-school youths in Lagos, Ekiti, Edo and Delta states in Nigeria. A total of 20 IDIs and 6 FGDs were conducted among 92 Nigerian youths of age 15 25 years. Data was also complemented from school reports, participants' feedback from youth drug abuse sensitization workshops and desk reviews. Data were analyzed using thematic analysis to describe emerging themes. Results: Thesex distribution of the participants was 60.1% males and 39.1% females. The main findings for non-medical use of tramadol among the youths were; to enhance sexual excitement (prolong ejaculation), to feel less hungry (reduce the desire for and food) to sustain hard labor (reduce pain, withstand prolong manual labor). The respondents also revealed that tramadol in combination with other substances will give them a euphoric effect. However, many of youths are ignorant of the risk of the non-medical use of tramadol. Conclusion: Tramadol abusehas become widespread in the Nigerian environment among the youths. The findings from this study revealed that the choice of tramadol use for non-medical purposes is a result of different effects discovered in the use which could pose potential harm to the abuser. Therefore, public health approaches should be adopted in preventing the abuse of tramadol among the youth.
Antecedentes: El presente estudio explora las opiniones de los jóvenes nigerianos sobre las razones que los impulsan a utilizar tramadol con fines no médicos, y busca conocer sus preferencias al elegir tramadol. Métodos: Se llevaron a cabo entrevistas en profundidad (IDIs) y discusiones en grupo (FGDs) entre estudiantes de escuelas secundarias, instituciones terciarias y jóvenes fuera del sistema educativo en los estados de Lagos, Ekiti, Edo y Delta en Nigeria. Se realizaron un total de 20 IDIs y 6 FGDs con 92 jóvenes nigerianos de entre 15 y 25 años. Además, se complementaron los datos con informes escolares, comentarios de los participantes en talleres de sensibilización sobre el abuso de drogas en jóvenes y revisiones bibliográficas. Los datos se analizaron utilizando análisis temáticos para describir los temas emergentes. Resultados: La distribución por sexo de los participantes fue del 60,1% de hombres y el 39,1% de mujeres. Los principales hallazgos sobre el uso no médico de tramadol entre los jóvenes fueron: para aumentar la excitación sexual (prolongar la eyaculación), reducir el apetito (disminuir el deseo de comer) y resistir trabajos pesados (reducir el dolor, aguantar labores manuales prolongadas). Los encuestados también revelaron que la combinación de tramadol con otras sustancias les produce un efecto eufórico. Sin embargo, muchos jóvenes desconocen los riesgos del uso no médico de tramadol. Conclusión: El abuso de tramadol se ha vuelto generalizado entre los jóvenes nigerianos. Los hallazgos de este estudio revelaron que la elección del uso no médico de tramadol se debe a los diferentes efectos descubiertos en su uso, lo que podría representar un riesgo potencial para el consumidor. Por lo tanto, se deben adoptar enfoques de salud pública para prevenir el abuso de tramadol entre los jóvenes.
Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Tramadol , Uso Indevido de Medicamentos sob Prescrição/estatística & dados numéricos , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Demografia , Estudos de Avaliação como Assunto , Medicamentos sob Prescrição/uso terapêutico , Analgésicos Opioides/uso terapêutico , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Nigéria/epidemiologiaAssuntos
Transtornos Relacionados ao Uso de Opioides , Pandemias , Analgésicos Opioides/efeitos adversos , Humanos , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Transtornos Relacionados ao Uso de Opioides/prevenção & controleRESUMO
BACKGROUND: American Indian and Alaska Native (AI/AN) youth face stark inequities in opioid misuse, social support, and suicide attempt. This study examined trends in these behavioral measures among AI/AN students in New Mexico (NM). METHODS: Using the NM oversampled Youth Resiliency and Risk Survey (NM-YRRS, 2009 - 2019: odd years), prevalence estimates of opioid misuse, social support (SS), and suicide attempt for AI/AN high school students were generated. Trends over time were assessed via linear regression of weighted proportions according to Peter Armitage. Stratified trends by demographics were also employed. RESULTS: While the prevalence of suicide attempt did not change significantly over time, it was consistently higher among females (2011-2019), those who misused opioids, received low social support, had a mother with less than high school education, had a C, D, or F for academic performance, and non-straight students relative to their counterparts. In particular, the prevalence of suicide attempt among AI/AN students who reported opioid misuse in 2009 was significantly higher by 25.4% than their counterparts who did not report opioid misuse (35.8% vs. 10.4%.) A significant decreasing trend over time (2009-2017) was observed for opioid misuse (16.1%↓8.8%, p-value = 0.0033), including when stratifying by sex (males: 15.9%↓9%, p-value = 0.002; females: 16.2%↓8.6%, p-value = 0.012). Youth with high maternal education exhibited significant decline in opioid misuse (13.5%↓6.7%, p-value = 0.019; 2011-2017.) Opioid misuse increased significantly from 2017 to 2019 (8.8%↑12.9%, p-value < 0.0001.) For instance, in 2019 among AI/AN students who reported low social support, opioid misuse was roughly doubled (18.9% vs. 8.5%, p < 0.0001), and suicide attempt was tripled (21.3% vs. 7.0%, p < 0.0001) compared to students with high social support. CONCLUSION: No significant trend was observed for suicide attempt. We observed a significant decreasing trend in opioid misuse between 2009 through 2017 but a significant increase from 2017 to 2019. A higher level of maternal education (college or above), and an A or B school grade performance were protective against both opioid misuse and suicide attempt.
Assuntos
Nativos do Alasca , Indígenas Norte-Americanos , Transtornos Relacionados ao Uso de Opioides , Adolescente , Feminino , Humanos , Masculino , New Mexico/epidemiologia , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Prevalência , Apoio Social , Estudantes , Tentativa de Suicídio , Indígena Americano ou Nativo do AlascaRESUMO
BACKGROUND: Neonatal abstinence syndrome (NAS) incidence has significantly increased in the US in recent years. It is therefore important to develop effective intervention protocols that mitigate the long-term consequences of this condition for the mother, her child, and the community. METHODS: We used Monte Carlo simulation to estimate the impact of four interventions for NAS and their combinations on pregnant women with opioid use disorder. The key outputs were changes in incremental costs from baseline from the Medicaid perspective and from a total systems perspective and effect size changes. Simulation parameters and costs were based on the literature and baseline model validation was performed using Medicaid claims for Indiana. RESULTS: Compared to baseline, the resulting simulation estimates showed that three interventions significantly decreased Medicaid incremental costs by 8% (mandatory opioid testing (MOT)), 4% (patient navigators), and 3% (peer recovery coaches). The combination of the three interventions reduced Medicaid direct costs by 26%. Reductions were similar for total system incremental costs (ranging from 2 to 24%), though MOT was found to increase costs of overdose death based on productivity loss. NAS case reductions ranged from 1% (capacity change) to 13% (MOT). CONCLUSIONS: Using systems-based modeling, we showed that costs associated with NAS can be significantly reduced. However, effective implementation would require the involvement and coordination of several stakeholders. In addition, careful protocols for MOT should be considered to ensure pregnant women don't forgo prenatal care for fear of punitive consequences.
Assuntos
Síndrome de Abstinência Neonatal , Transtornos Relacionados ao Uso de Opioides , Analgésicos Opioides , Custos e Análise de Custo , Feminino , Humanos , Recém-Nascido , Medicaid , Mães , Síndrome de Abstinência Neonatal/epidemiologia , Síndrome de Abstinência Neonatal/terapia , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Gravidez , Estados UnidosRESUMO
BACKGROUND: Anesthetic and/or opioid abuse is more prevalent among anesthesiologists than in other medical specialties and it has been associated with high mortality. The aim of this study was to evaluate factors associated with lethal anesthetic and/or opioid abuse among anesthesiologists. METHODS: We evaluated psychological factors, and occupational history and circumstances of death of anesthesiologists who died from anesthetic abuse. Data were obtained post-mortem from colleagues, and relatives. After finding eligible cases, we identified the key informants, who were interviewed personally or via email, through the qualitative method known as "Psychological Autopsy". RESULTS: Eighteen cases of death were identified, but we were able to interview 44% of them (n = 8), most of whom were young males. They died at home or at the hospital and were found "at the scene". Being an introspective person who did not share personal issues at workplace was the most prevalent personal characteristic. At work, they seemed to perform very well their functions, but some presented subtle changes such as to staying more than usual at the workplace and/or neglecting some of their responsibilities. The main reported factors to explain their substance abuse were emotional problems including psychiatric, excessive hours of work, and other health factors. CONCLUSION: This study identified that emotional disturbances, compulsive work, and general health problems were the more prominent factors involved with those deaths. Further, larger studies are needed to better understand how these factors could be early identified in order to timely prevent anesthetic and/or opioid abuse and several deaths among anesthesiologists.
Assuntos
Anestésicos , Transtornos Relacionados ao Uso de Opioides , Anestesiologistas , Autopsia , Humanos , Masculino , Transtornos Relacionados ao Uso de Opioides/epidemiologiaRESUMO
OBJECTIVES: To describe trends in the number of youths diagnosed with opioid use disorder (OUD) and to identify factors associated with OUD diagnosis in acute care settings. STUDY DESIGN: Data from a population-based retrospective cohort study with linkage of 6 health administrative databases for 13 009 youth age 12-24 years identified with OUD between 2001 and 2018 in British Columbia, Canada were used to describe annual diagnoses. Using a multiple logistic regression model, we estimated the association between past-year health care utilization and OUD diagnosis in acute settings, controlling for sociodemographic and OUD-related comorbid conditions. RESULTS: Annual OUD diagnoses quadrupled between 2003 and 2017 (from 326 to 1473). Among the 6579 youth diagnosed with OUD between April 1, 2013 and September 30, 2018, 88.1% had past-year health system contacts. Youth age 12-18 had higher odds of OUD diagnosis in acute care (aOR 2.04; 95% CI 1.78, 2.34). Compared with no health care contact, youth receiving outpatient care only were less likely to be diagnosed with OUD in acute care (aOR 0.69; 95% CI 0.56, 0.84) and those with >1 urgent hospitalization were more likely to be diagnosed with OUD in acute care (aOR 1.87; 95% CI 1.40,2.49). CONCLUSIONS: More than 88% of youth had past-year health system contacts prior to diagnosis. Those age 12-18 years and with urgent hospitalizations in the year prior to diagnosis were more likely to have OUD diagnosed in acute care settings. Establishing an effective evidence-based system for early detection and intervention among youth with OUD must be a priority.
Assuntos
Transtornos Relacionados ao Uso de Opioides/diagnóstico , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Adolescente , Assistência Ambulatorial/estatística & dados numéricos , Colúmbia Britânica/epidemiologia , Criança , Bases de Dados Factuais , Utilização de Instalações e Serviços/estatística & dados numéricos , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Transtornos Relacionados ao Uso de Opioides/etiologia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Prevalência , Estudos Retrospectivos , Fatores de Risco , Adulto JovemRESUMO
BACKGROUND: Global opioid consumption increased multifold post-2000, disproportionately in high-income countries, with severe mortality/morbidity consequences. Latin America features comparatively low opioid availability; Brazil, the region's most populous country, makes an interesting case study concerning opioid use/harms. In this comprehensive overview, we aimed to identify and summarize medical and non-medical data and indicators of opioid availability and use, regulation/control, and harm outcomes in Brazil since 2000. METHODS: We searched multiple scientific databases to identify relevant publications and conducted additional 'grey' literature searches to identify other pertinent information. RESULTS: Despite some essential indicators, opioid-related data are limited for Brazil. Data indicate that population-level availability of prescription opioids represents only a small fraction of use in comparison to high-income countries. However, within Latin America, Brazil ranks mid-level for opioid consumption, indicating relatively moderate consumption compared to neighboring jurisdictions. Brazil has implemented restrictive regulations to opioid prescribing and is considered 'highly restricted' for opioid access. Codeine remains the major opioid analgesic utilized, but stronger opioids such as oxycodone are becoming more common. Professional knowledge regarding medical opioid use and effects appears limited. National surveys indicate increases in non-medical use of prescription opioids, albeit lower than observed in North America, while illicit opioids (e.g., heroin) are highly uncommon. CONCLUSIONS: Overall population-level opioid availability and corresponding levels of opioid-related harms in Brazil remain substantially lower than rates reported for North America. However, the available surveillance and analytical data on opioid use, policy/practice, and harms in Brazil are limited and insufficient. Since existing and acute (e.g., pain-related) needs for improved opioid utilization and practice appear to be substantiated, improved indicators for and understanding of opioid use, practice, and harms in Brazil are required.
Assuntos
Analgésicos Opioides , Transtornos Relacionados ao Uso de Opioides , Analgésicos Opioides/efeitos adversos , Brasil/epidemiologia , Humanos , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Dor/tratamento farmacológico , Padrões de Prática MédicaRESUMO
Opioid use disorder (OUD) is an unprecedented medical and public health issue both in Puerto Rico (PR) and the greater US with an increase incidence of opioid use every year. Unprecedented and compounded emergencies in PR such as those caused by hurricanes, earthquakes, and the COVID-19 pandemic coupled with limited national and local governmental support, has forced most clinics in PR to take action to be able to continue providing care. This commentary summarizes the leadership and clinical initiatives of 3 community organizations in PR to maintain services for people with OUD during the COVID-19 pandemic. Local legislation that supported the continuity of OUD care is summarized, along with unique experiences specific to each organization. In addition, the vulnerability of economically disadvantaged people or experiencing homelessness as well as those affected by these compounded events in PR is discussed, with an emphasis on how some challenges were addressed and future directions for continuity of care as our country adjusts to new demands caused by the COVID-19 pandemic.
Assuntos
COVID-19 , Transtornos Relacionados ao Uso de Opioides , Humanos , Liderança , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Transtornos Relacionados ao Uso de Opioides/terapia , Pandemias , Porto Rico/epidemiologia , SARS-CoV-2RESUMO
The objective of this cohort study was to determine the association between the use of tramadol in emergency departments and the later consumption of opioids at the outpatient level in a group of patients from Colombia. Based on a medication dispensation database, patients over 18 years of age treated in different clinics in Colombia who for the first time received tramadol, dipyrone, or a nonsteroidal anti-inflammatory drug (NSAID) in the emergency room between January and December 2018 were identified. Three mutually exclusive cohorts were created, and each patient was followed up for 12 months after the administration of the analgesic to identify new formulations of any opioid. A Cox proportional-hazards regression model was constructed to identify variables associated with receiving a new opioid. A total of 12,783 patients were identified: 6020 treated with dipyrone, 5309 treated with NSAIDs, and 1454 treated with tramadol. The mean age was 47.1 ± 20.4 years, and 61.6% were women. A total of 17.3% (n = 2207) of all patients received an opioid during follow-up. Those treated with tramadol received a new opioid with a higher frequency (n = 346, 23.8%) than the other cohorts (14.7% NSAIDs and 17.9% dipyrone, both p < 0.001). In the tramadol group, using more than 10 mg of morphine equivalents was associated with a greater use of new opioids (HR:1.47, 95%CI:1.12-1.93). Patients treated with tramadol in emergency departments have a higher risk of opioid use at the one-year follow-up than those treated with NSAIDs or dipyrone.
Assuntos
Analgésicos Opioides/uso terapêutico , Serviços Médicos de Emergência/tendências , Serviço Hospitalar de Emergência/tendências , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Tramadol/uso terapêutico , Adulto , Idoso , Analgésicos Opioides/efeitos adversos , Estudos de Coortes , Colômbia/epidemiologia , Serviços Médicos de Emergência/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Morfina/efeitos adversos , Morfina/uso terapêutico , Transtornos Relacionados ao Uso de Opioides/diagnóstico , Fatores de Risco , Tramadol/efeitos adversos , Resultado do TratamentoRESUMO
OBJECTIVES: To estimate the proportion of opioid misuse attributable to adverse childhood experiences (ACEs) among adolescents. STUDY DESIGN: A cross-sectional survey was administered to 10 546 seventh-to twelfth-grade students in northeastern Ohio in Spring 2018. Study measures included self-reported lifetime exposure to 10 ACEs and past 30-day use of nonmedical prescription opioid or heroin. Using generalized estimating equations, we evaluated associations between recent opioid misuse, individual ACEs, and cumulative number of ACEs. We calculated population attributable fractions to determine the proportion of adolescents' recent opioid misuse attributable to ACEs. RESULTS: Nearly 1 in 50 adolescents reported opioid misuse within 30 days (1.9%); approximately 60% of youth experienced ≥1 ACE; 10.2% experienced ≥5 ACEs. Cumulative ACE exposure demonstrated a significant graded relationship with opioid misuse. Compared with youth with zero ACEs, youth with 1 ACE (aOR 1.9, 95% CI, 0.9-3.9), 2 ACEs (aOR, 3.8; 95% CI, 1.9-7.9), 3 ACEs (aOR, 3.7; 95% CI, 2.2-6.5), 4 ACEs (aOR, 5.8; 95% CI, 3.1-11.2), and ≥5 ACEs (aOR, 15.3; 95% CI, 8.8-26.6) had higher odds of recent opioid misuse. The population attributable fraction of recent opioid misuse associated with experiencing ≥1 ACE was 71.6% (95% CI, 59.8-83.5). CONCLUSIONS: There was a significant graded relationship between number of ACEs and recent opioid misuse among adolescents. More than 70% of recent adolescent opioid misuse in our study population was attributable to ACEs. Efforts to decrease opioid misuse could include programmatic, policy, and clinical practice interventions to prevent and mitigate the negative effects of ACEs.
Assuntos
Experiências Adversas da Infância/estatística & dados numéricos , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Adolescente , Experiências Adversas da Infância/psicologia , Causalidade , Estudos de Coortes , Estudos Transversais , Feminino , Humanos , Masculino , Ohio/epidemiologia , Transtornos Relacionados ao Uso de Opioides/psicologiaRESUMO
Prior studies on substance use in Brazil have not focused on opioid misuse, previously thought to be nearly non-existent. This paper presents new findings on heroin and non-medical use of opioid analgesics. Data come from the 2015 Brazilian Household Survey on Substance Use (BHSU-3), a nationally representative survey estimating epidemiological parameters related to substance use by residents across Brazil. BHSU-3 used stratified multi-stage probability sampling across multiple geographic domains of interest, resulting in 16,273 interviews with household residents. Lifetime heroin use among Brazilians was 0.3 (95% C.I:0.2-0.4). Lifetime, past-year, and past-month non-medical use of opioid analgesics were respectively 2.9 (95%C.I.:2.3-3.4), 1.4 (95%C.I.:1.1-1.7) and 0.6 (95%C.I.:0.4-0.8). Past-year prevalence of non-medical opioid analgesics use was lower among males [Prevalence Ratio (PR): 0.54 (95% C.I.:0.36-0.78)], those aged 12-24 [0.56 (95% C.I.:0.34-0.92)], persons with monthly family incomes between R$1,501-3,000 [0.59 (95% C.I.:0.38-0.92)] or greater than R$3,000 [0.64 (95% C.I.:0.42-0.98)], and persons who were unemployed [0.65 (95% C.I.:0.46-0.92)]. Non-medical use of opioids in Brazil may be more prevalent than previously recognised. Proper measurement and evaluation of opioid misuse across Brazil and other Latin American countries is critical to understand and prevent opioid-related harms.
Assuntos
Analgésicos Opioides , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Uso Indevido de Medicamentos sob Prescrição/estatística & dados numéricos , Adolescente , Adulto , Idoso , Brasil , Criança , Feminino , Inquéritos Epidemiológicos , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Adulto JovemRESUMO
This population-based study showed that maternal opioid plus marijuana use during pregnancy was associated with increased odds of prematurity and low birth weight but lower odds of neonatal abstinence syndrome and prolonged hospitalization compared with opioid exposure without marijuana use. Further research should evaluate the biologic mechanisms responsible for these outcomes.
Assuntos
Abuso de Maconha/epidemiologia , Uso da Maconha/efeitos adversos , Síndrome de Abstinência Neonatal/epidemiologia , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Adolescente , Adulto , Analgésicos Opioides/efeitos adversos , Cannabis/efeitos adversos , Criança , Coleta de Dados , Bases de Dados Factuais , Feminino , Hospitalização , Humanos , Recém-Nascido de Baixo Peso , Recém-Nascido , Doenças do Recém-Nascido/epidemiologia , Doenças do Recém-Nascido/prevenção & controle , Masculino , Abuso de Maconha/complicações , Abuso de Maconha/prevenção & controle , Fumar Maconha/efeitos adversos , Massachusetts/epidemiologia , Síndrome de Abstinência Neonatal/complicações , Síndrome de Abstinência Neonatal/prevenção & controle , Transtornos Relacionados ao Uso de Opioides/complicações , Transtornos Relacionados ao Uso de Opioides/prevenção & controle , Avaliação de Resultados em Cuidados de Saúde , Gravidez , Complicações na Gravidez , Adulto JovemRESUMO
OBJECTIVE: To examine the prevalence and characteristics of pediatric opioid exposures and poisonings in the US. STUDY DESIGN: This was a retrospective, cross-sectional analysis using the National Poison Data System from January 1, 2010 to December 31, 2014. Records of children aged <18 years with exposure to opioid-containing medications were identified. Standardized prevalence rates were calculated, and the annual trend was examined. Pediatric opioid exposures were characterized descriptively, and logistic regression was performed to estimate the association between various clinical and sociodemographic characteristics and exposures with serious (ie, moderate, major, or death) outcomes. The association of pediatric opioid exposures and area-level socioeconomic status factors at 5-digit ZIP code level was examined descriptively. RESULTS: The prevalence of opioid exposures was 22.6 per 100 000 children and was particularly high among ≤5-year-olds. Prevalence declined from 25.5 to 20 per 100 000 children from 2010 to 2014. There were 83 418 pediatric opioid exposures over the 5-year period and nearly one-half resulted in poisoning. Over 60% of exposures were among children ≤5 years of age, 73.4% were unintentional, and over 90% occurred at home. One in every 2 pediatric opioid exposures was evaluated in a healthcare facility. Annually 4912 children aged ≤5 years were treated in the emergency department or admitted for care. Older age, nonaccidental intent, and single-substance opioid, especially buprenorphine and methadone, were associated with serious outcomes (P < .05). Positive correlations were observed for area-level socioeconomic status factors including proportion of adults and pediatric opioid exposures. CONCLUSIONS: Pediatric opioid exposures and poisonings decreased from 2010 to 2014 but morbidity remains high. The epidemiology of opioid exposures differed considerably by age.
Assuntos
Analgésicos Opioides/intoxicação , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Adolescente , Criança , Pré-Escolar , Estudos Transversais , Bases de Dados Factuais , Feminino , Humanos , Lactente , Masculino , Prevalência , Estudos Retrospectivos , Fatores Socioeconômicos , Estados Unidos/epidemiologiaRESUMO
In North America, opioid use and its harms have increased in the United States and Canada over the past 2 decades. However, Mexico has yet to document patterns suggesting a higher level of opioid use or attendant harms.Historically, Mexico has been a country with low-level use of opioids, although heroin use has been documented. Low-level opioid use is likely attributable to structural, cultural, and individual factors. However, a range of dynamic factors may be converging to increase the use of opioids: legislative changes to opioid prescribing, national health insurance coverage of opioids, pressure from the pharmaceutical industry, changing demographics and disease burden, forced migration and its trauma, and an increase in the production and trafficking of heroin. In addition, harm-reduction services are scarce.Mexico may transition from a country of low opioid use to high opioid use but has the opportunity to respond effectively through a combination of targeted public health surveillance of high-risk groups, preparation of appropriate infrastructure to support evidence-based treatment, and interventions and policies to avoid a widespread opioid use epidemic.