scholarly journals Opioid Mortality Following Implementation of Medical Cannabis Programs in the United States

2021 ◽  
Author(s):  
Daniel E. Kaufman ◽  
Asawer M. Nihal ◽  
Janan D. Leppo ◽  
Kelly M. Staples ◽  
Kenneth L. McCall ◽  
...  
Keyword(s):  
United States ◽  
Death Certificate ◽  
Reporting Quality ◽  
Interrupted Time Series ◽  
The United States ◽  
Opioid Overdose ◽  
Medicaid Expansion ◽  
Protective Effects ◽  
Medical Cannabis ◽  
Overdose Deaths

Abstract Introduction The United States is in the midst of an opioid overdose epidemic. Emerging evidence suggests that medical cannabis (MC) may reduce use of opioids for pain in some individuals, with potential impacts on opioid-related overdose. However, there may be other important differences between states that did, and did not, adopt MC. Methods This study evaluated differences following legal MC sales on US opioid-related overdose deaths, corrected for population, from 1999 to 2017 using an interrupted time series. Comparisons by MC status were also made for Medicaid expansion and the Centers for Disease Control death certificate reporting quality (0: <good, 1: good, 2: excellent). Results Overdose deaths were significantly higher in MC states from 2012–2017. Overdose death slopes over time increased in states with (pre=1.46±0.46, post=2.90±0.58, p<0.05) and without (pre =0.20±.10, post=1.04±0.22, p<0.005) MC. Post-legalization slopes were significantly higher in MC states (p<0.01). Two states without (11.1%) as compared to 11 states with (91.7%) MC expanded Medicaid by 2014 (χ2[1]=19.03, p<0.0005). MC states (1.50±0.23) had higher death certificate reporting quality relative to states without MC (0.78±0.22, p<0.05). Discussion MC states had higher rates of opioid overdoses. Although there was no decrease in association with MC introduction, these results were confounded by states without MC having lower overdose reporting quality. Medicaid expansion was also more common in states with MC. Finally, the potency of fentanyl analogues may have obscured any protective effects of MC against illicit opioid harms.

scholarly journals Opioid mortality following implementation of medical marijuana programs (1999-2017) in the United States

2019 ◽  
Author(s):  
Daniel E. Kaufman ◽  
Asawer M. Nihal ◽  
Janan D. Leppo ◽  
Kelly M. Staples ◽  
Kenneth L. McCall ◽  
...  
Keyword(s):  
United States ◽  
Reporting Quality ◽  
Interrupted Time Series ◽  
The United States ◽  
Opioid Overdose ◽  
Protective Effects ◽  
Medical Cannabis ◽  
Online Data ◽  
Cannabis Policy ◽  
Overdose Deaths

AbstractThe United States is in the midst of an opioid overdose epidemic. A prior report using the Center for Disease Control’s Wide-ranging Online Data for Epidemiologic Research (WONDER) database discovered that opioid overdoses decreased by 24.8% from 1999 to 2010 in states with medical cannabis (MC+) relative to those without (MC−). The present study evaluated any differences following MC legislation on WONDER reported opioid overdoses, corrected for population, from 1999 to 2017 using an interrupted time series. Overdoses were significantly higher in MC+ states from 2012-2017. The slope of opioid overdose deaths over time increased significantly post-implementation in states without MC (3-years Pre = 0.1 ± 0.1, 3-years Post = 0.7 ± 0.2, t(16) = 2.88, p ≤ .011). Overdose deaths showed a non-significant elevation in states with MC (Pre = 1.3 ± 0.3, Post = 2.8 ± 0.8, t(11) = 2.01, p = .069). Post-legalization slopes were significantly higher in MC+ than MC− (t(11.95) = 2.70, p < .05). Overall, any impact of medical cannabis laws on opioid overdoses appears modest. There are other confounds (e.g. death determination reporting quality) which differ non-randomly among states and are non-trivial to account for in ecological investigations of cannabis policy. Alternatively, the potency of fentanyl analogues may obscure any protective effects of MC against illicit opioid harms.

Commercial Fishing as an Occupational Determinant of Opioid Overdoses and Deaths of Despair in Two Massachusetts Fishing Ports, 2000–2014

2021 ◽  
pp. 104829112110234
Author(s):  
Scott Fulmer ◽  
Shruti Jain ◽  
David Kriebel
Keyword(s):  
United States ◽  
Cause Of Death ◽  
Death Certificate ◽  
The United States ◽  
Opioid Overdose ◽  
Commercial Fishing ◽  
Opioid Epidemic ◽  
Death Certificate Data ◽  
Deaths Of Despair

The opioid epidemic has had disproportionate effects across various sectors of the population, differentially impacting various occupations. Commercial fishing has among the highest rates of occupational fatalities in the United States. This study used death certificate data from two Massachusetts fishing ports to calculate proportionate mortality ratios of fatal opioid overdose as a cause of death in commercial fishing. Statistically significant proportionate mortality ratios revealed that commercial fishermen were greater than four times more likely to die from opioid poisoning than nonfishermen living in the same fishing ports. These important quantitative findings suggest opioid overdoses, and deaths to diseases of despair in general, deserve further study in prevention, particularly among those employed in commercial fishing.

scholarly journals Mortality among Adults Ages 25-44 in the United States During the COVID-19 Pandemic

2020 ◽  
Author(s):  
Jeremy Samuel Faust ◽  
Harlan M. Krumholz ◽  
Katherine L. Dickerson ◽  
Zhenqiu Lin ◽  
Cleavon Gilman ◽  
...  
Keyword(s):  
United States ◽  
New York ◽  
The United States ◽  
Relative Increase ◽  
Opioid Overdose ◽  
Public Data ◽  
Control And Prevention ◽  
Incident Rate ◽  
Opioid Deaths ◽  
Overdose Deaths

AbstractIntroductionCoronavirus disease-19 (COVID-19) has caused a marked increase in all-cause deaths in the United States, mostly among adults aged 65 and older. Because younger adults have far lower infection fatality rates, less attention has been focused on the mortality burden of COVID-19 in this demographic.MethodsWe performed an observational cohort study using public data from the National Center for Health Statistics at the United States Centers for Disease Control and Prevention, and CDC Wonder. We analyzed all-cause mortality among adults ages 25-44 during the COVID-19 pandemic in the United States. Further, we compared COVID-19-related deaths in this age group during the pandemic period to all drug overdose deaths and opioid-specific overdose deaths in each of the ten Health and Human Services (HHS) regions during the corresponding period of 2018, the most recent year for which data are available.ResultsAs of September 6, 2020, 74,027 all-cause deaths occurred among persons ages 25-44 years during the period from March 1st to July 31st, 2020, 14,155 more than during the same period of 2019, a 23% relative increase (incident rate ratio 1.23; 95% CI 1.21–1.24), with a peak of 30% occurring in May (IRR 1.30; 95% CI 1.27-1.33). In HHS Region 2 (New York, New Jersey), HHS Region 6 (Arkansas, Louisiana, New Mexico, Oklahoma, Texas), and HHS Region 9 (Arizona, California, Hawaii, Nevada), COVID-19 deaths exceeded 2018 unintentional opioid overdose deaths during at least one month. Combined, 2,450 COVID-19 deaths were recorded in these three regions during the pandemic period, compared to 2,445 opioid deaths during the same period of 2018.MeaningWe find that COVID-19 has likely become the leading cause of death—surpassing unintentional overdoses—among young adults aged 25-44 in some areas of the United States during substantial COVID-19 outbreaks.NoteThe data presented here have since been updated. As a result, an additional 1,902 all-cause deaths occurring among US adults ages 25-44 during the period of interest are not accounted for in this manuscript.

Reframing the Prevention Strategies of the Opioid Crisis: Focusing on Prescription Opioids, Fentanyl, and Heroin Epidemic

2018 ◽  
Vol 1 (21;1) ◽  
pp. 309-326 ◽  
Author(s):  
Laxmaiah Manchikanti
Keyword(s):  
United States ◽  
The United States ◽  
Opioid Overdose ◽  
Prescription Opioids ◽  
Opioid Epidemic ◽  
Synthetic Opioids ◽  
Opioid Crisis ◽  
Electronic Reporting ◽  
Number Of Patients ◽  
Overdose Deaths

The opioid epidemic has been called the “most consequential preventable public health problem in the United States.” Though there is wide recognition of the role of prescription opioids in the epidemic, evidence has shown that heroin and synthetic opioids contribute to the majority of opioid overdose deaths. It is essential to reframe the preventive strategies in place against the opioid crisis with attention to factors surrounding the illicit use of fentanyl and heroin. Data on opioid overdose deaths shows 42,000 deaths in 2016. Of these, synthetic opioids other than methadone were responsible for over 20,000, heroin for over 15,000, and natural and semisynthetic opioids other than methadone responsible for over 14,000. Fentanyl deaths increased 520% from 2009 to 2016 (increased by 87.7% annually between 2013 and 2016), and heroin deaths increased 533% from 2000 to 2016. Prescription opioid deaths increased by 18% overall between 2009 and 2016. The Drug Enforcement Administration (DEA) mandated reductions in opioid production by 25% in 2017 and 20% in 2018. The number of prescriptions for opioids declined significantly from 252 million in 2013 to 196 million in 2017 (9% annual decline over this period), falling below the number of prescriptions in 2006. In addition, data from 2017 shows significant reductions in the milligram equivalence of morphine by 12.2% and in the number of patients receiving high dose opioids by 16.1%. This manuscript describes the escalation of opioid use in the United States, discussing the roles played by drug manufacturers and distributors, liberalization by the DEA, the Food and Drug Administration (FDA), licensure boards and legislatures, poor science, and misuse of evidencebased medicine. Moreover, we describe how the influence of pharma, improper advocacy by physician groups, and the promotion of literature considered peer-reviewed led to the explosive use of illicit drugs arising from the issues surrounding prescription opioids. This manuscript describes a 3-tier approach presented to Congress. Tier 1 includes an aggressive education campaign geared toward the public, physicians, and patients. Tier 2 includes facilitation of easier access to non-opioid techniques and the establishment of a National All Schedules Prescription Electronic Reporting Act (NASPER). Finally, Tier 3 focuses on making buprenorphine more available for chronic pain management as well as for medication-assisted treatment. Key words: Opioid epidemic, fentanyl and heroin epidemic, prescription opioids, National All Schedules Prescription Electronic Reporting Act (NASPER), Prescription Drug Monitoring Programs (PDMPs)

scholarly journals Alcohol or Benzodiazepine Co-involvement With Opioid Overdose Deaths in the United States, 1999-2017

2020 ◽  
Vol 3 (4) ◽  
pp. e202361 ◽  
Author(s):  
Marco E. Tori ◽  
Marc R. Larochelle ◽  
Timothy S. Naimi
Keyword(s):  
United States ◽  
The United States ◽  
Opioid Overdose ◽  
Overdose Deaths

scholarly journals Trends in Intentional and Unintentional Opioid Overdose Deaths in the United States, 2000-2017

JAMA ◽  
2019 ◽  
Vol 322 (23) ◽  
pp. 2340 ◽  
Author(s):  
Mark Olfson ◽  
Lauren M. Rossen ◽  
Melanie M. Wall ◽  
Debra Houry ◽  
Carlos Blanco
Keyword(s):  
United States ◽  
The United States ◽  
Opioid Overdose ◽  
Overdose Deaths

scholarly journals The Opioid Epidemic and Nonmarital Childbearing in the United States, 2000–2016

Demography ◽  
2021 ◽  
Vol 58 (1) ◽  
pp. 345-378
Author(s):  
Mónica L. Caudillo ◽  
Andrés Villarreal
Keyword(s):  
United States ◽  
Local Level ◽  
The United States ◽  
Unaffected Individual ◽  
Opioid Overdose ◽  
Opioid Epidemic ◽  
Nonmarital Birth ◽  
Birth Rates ◽  
Individual Level ◽  
Overdose Deaths

Abstract The United States has experienced a dramatic rise in opioid addiction and opioid overdose deaths in recent years. We investigate the effect of the opioid epidemic at the local level on nonmarital fertility using aggregate- and individual-level analyses. Opioid overdose death rates and prescriptions per capita are used as indicators of the intensity of the opioid epidemic. We estimate area fixed-effects models to test the effect of the opioid epidemic on nonmarital birth rates obtained from vital statistics for 2000–2016. We find an increase in nonmarital birth rates in communities that experienced a rise in opioid overdose deaths and higher prescription rates. Our analyses also show that the local effect of the opioid epidemic is not driven by a reduction in marriage rates and that marital birth rates are unaffected. Individual-level data from the ACS 2008–2016 are then used to further assess the potential causal mechanisms and to test heterogeneous effects by education and race/ethnicity. Our findings suggest that the opioid epidemic increased nonmarital birth rates through social disruptions primarily affecting unmarried women but not through changes in their economic condition.

scholarly journals Social Determinants of the Recent Decline in US Life Expectancy

2020 ◽  
Author(s):  
Sam Harper ◽  
Corinne Riddell ◽  
Nicholas King
Keyword(s):  
United States ◽  
Life Expectancy ◽  
The United States ◽  
Opioid Overdose ◽  
Recent Trends ◽  
And Gender ◽  
Gender Groups ◽  
The Life Course ◽  
Overdose Deaths

In recent years life expectancy has stagnated in the United States, followed by three consecutive years of decline. The decline is small in absolute terms, but is unprecedented and has generated considerable research interest and theorizing about potential causes. Recent trends show the decline has affected nearly all race-ethnic and gender groups, and the proximate causes of the decline are increases in opioid overdose deaths, suicide, homicide, and Alzheimer’s disease. A slowdown in the long-term decline in mortality from cardiovascular diseases has also prevented life expectancy from further improvements. Although a popular explanation for the decline is the cumulative decline in living standards across generations, recent trends suggest that distinct mechanisms for specific causes of death are more plausible explanations. Interventions to stem the increase in overdose deaths, reduce access to mechanisms that contribute to violent deaths, and decrease cardiovascular risk over the life course are urgently needed to improve mortality in the United States.

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

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

scholarly journals Opioid use in medical cannabis authorization adult patients from 2013 to 2018: Alberta, Canada

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Cerina Lee ◽  
Mu Lin ◽  
Karen J. B. Martins ◽  
Jason R. B. Dyck ◽  
Scott Klarenbach ◽  
...  
Keyword(s):  
Oral Morphine ◽  
Interrupted Time Series ◽  
The United States ◽  
Adult Patients ◽  
Opioid Overdose ◽  
Medical Cannabis ◽  
Opioid Use ◽  
Absolute Increase ◽  
Health Crisis ◽  
Opioid Users

Abstract Background The opioid overdose epidemic in Canada and the United States has become a public health crisis - with exponential increases in opioid-related morbidity and mortality. Recently, there has been an increasing body of evidence focusing on the opioid-sparing effects of medical cannabis use (reduction of opioid use and reliance), and medical cannabis as a potential alternative treatment for chronic pain. The objective of this study is to assess the effect of medical cannabis authorization on opioid use (oral morphine equivalent; OME) between 2013 and 2018 in Alberta, Canada. Methods All adult patients defined as chronic opioid users who were authorized medical cannabis by their health care provider in Alberta, Canada from 2013 to 2018 were propensity score matched to non-authorized chronic opioid using controls. A total of 5373 medical cannabis patients were matched to controls, who were all chronic opioid users. The change in the weekly average OME of opioid drugs for medical cannabis patients relative to controls was measured. Interrupted time series (ITS) analyses was used to assess the trend change in OME during the 26 weeks (6 months) before and 52 weeks (1 year) after the authorization of medical cannabis among adult chronic opioid users. Results Average age was 52 years and 54% were female. Patients on low dose opioids (< 50 OME) had an increase in their weekly OME per week (absolute increase of 112.1 OME, 95% CI: 104.1 to 120.3); whereas higher dose users (OME > 100), showed a significant decrease over 6 months (− 435.5, 95% CI: − 596.8 to − 274.2) compared to controls. Conclusions This short-term study found that medical cannabis authorization showed intermediate effects on opioid use, which was dependent on initial opioid use. Greater observations of changes in OME appear to be in those patients who were on a high dosage of opioids (OME > 100); however, continued surveillance of patients utilizing both opioids and medical cannabis is warranted by clinicians to understand the long-term potential benefits and any harms of ongoing use.

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