scholarly journals Long-term Infective Endocarditis Mortality Associated With Injection Opioid Use in the United States: A Modeling Study

2020 ◽  
Author(s):  
Joshua A Barocas ◽  
Golnaz Eftekhari Yazdi ◽  
Alexandra Savinkina ◽  
Shayla Nolen ◽  
Caroline Savitzky ◽  
...  
Keyword(s):  
United States ◽  
Infective Endocarditis ◽  
Mortality Rate ◽  
Population Level ◽  
Risk Groups ◽  
The United States ◽  
Published Data ◽  
Opioid Epidemic ◽  
Opioid Use ◽  
Behavior Profiles

Abstract Background The expansion of the US opioid epidemic has led to significant increases in infections, such as infective endocarditis (IE), which is tied to injection behaviors. We aimed to estimate the population-level IE mortality rate among people who inject opioids and compare the risk of IE death against the risks of death from other causes. Methods We developed a microsimulation model of the natural history of injection opioid use. We defined injection behavior profiles by both injection frequency and injection techniques. We accounted for competing risks of death and populated the model with primary and published data. We modeled cohorts of 1 million individuals with different injection behavior profiles until age 60 years. We combined model-generated estimates with published data to project the total expected number of IE deaths in the United States by 2030. Results The probabilities of death from IE by age 60 years for 20-, 30-, and 40-year-old men with high-frequency use with higher infection risk techniques compared to lower risk techniques for IE were 53.8% versus 3.7%, 51.4% versus 3.1%, and 44.5% versus 2.2%, respectively. The predicted population-level attributable fraction of 10-year mortality from IE among all risk groups was 20%. We estimated that approximately 257 800 people are expected to die from IE by 2030. Conclusions The expected burden of IE among people who inject opioids in the United States is large. Adopting a harm reduction approach, including through expansion of syringe service programs, to address injection behaviors could have a major impact on decreasing the mortality rate associated with the opioid epidemic.

scholarly journals Addressing the Opioid Epidemic: Recommended Solutions from Physicians

2020 ◽  
Vol 4 (1) ◽  
Author(s):  
Jessica Cataldo ◽  
Sandra Collins ◽  
Richard C Mckinnies ◽  
Jane Nichols ◽  
Thomas A Shaw
Keyword(s):  
United States ◽  
Active Role ◽  
The United States ◽  
Opioid Epidemic ◽  
Opioid Misuse ◽  
Opioid Use ◽  
Multifaceted Approach ◽  
Improve Treatment ◽  
Opioid Crisis ◽  
A Current

The purpose of this study was to assess physicians’ accounts related to the current opioid epidemic and to identify solutions that they feel would be most successful in addressing opioid misuse and overuse. A survey was administered a group of physicians obtained from a nationwide database. Nearly all physicians surveyed believed there was a current opioid crisis in the United States and that physicians should take an active role in addressing opioid use in patients. Four key themes emerged regarding solutions to the opioid crisis: i) policy change, ii) improve treatment, iii) education, and iv) alternative treatment. The diversity of responses highlighted the need for a multifaceted approach to address opioid misuse and abuse.

scholarly journals A cross-sectional study of opioid involvement in non-poisoning suicide – risks and prevention opportunities

2020 ◽  
Author(s):  
Maryann Mason ◽  
Suzanne McLone ◽  
Tami Bartell ◽  
Sarah Welch ◽  
Karen Sheehan ◽  
...  
Keyword(s):  
United States ◽  
Suicide Prevention ◽  
The United States ◽  
Cross Sectional Study ◽  
Close Monitoring ◽  
Opioid Epidemic ◽  
Sectional Study ◽  
Opioid Use ◽  
Chi Square ◽  
Cross Sectional

Abstract Background The current opioid epidemic has drawn attention to drug overdose deaths including unintentional and suicide poisoning deaths which peaked in the United States in 2017. Concurrent with the opioid epidemic, the number and rate of suicides in the United States has increased. At the same time, the proportion of suicide deaths across cause of death has shifted and the proportion of suicides by poisoning (including overdose) has decreased. On the face of it, it would appear that the opioid epidemic has not intersected with suicide as signaled by the decline in suicide deaths due to poisoning. However, opioid use and misuse is associated with suicidal ideation and attempts and therefore it is plausible that opioids may play a role in suicide deaths by causes other than poisoning. Objective This study examines opioid involvement (as measured by the presence of opioids but below the lethality threshold) in suicides by causes other than poisoning, Methods A cross-sectional study utilizing Illinois National Violent Death Reporting System data including all suicides toxicology screened for opioids. Chi-square tests were used to compare decedent and incident circumstance characteristics by opioid toxicology screen status. Results Of 1007 non-poisoning suicides screened for opioids, 83.6% (842) were opioid negative and 16.4% (165) were opioid positive. Over half (52.7%) of decedents positive for opioids died by firearm. White race, age 75 and over, and widowed or unknown marital status were associated with opioid positivity. Opioid positivity is linked to testing positive for other substances. One quarter of decedents testing positive for opioids had a history of substance abuse. Twenty eight percent of opioid positive decedents suffered from physical health problems. Conclusion Suicide decedents who are opioid positive and who die from causes other than poisoning have distinct characteristics which suggest an array of suicide prevention efforts – for example -- including information on risk of suicide for opiate users in firearm sales, including suicide prevention counseling in health care settings in which opiates and/or benzodiazepines are therapeutically prescribed, and close monitoring of pain symptoms among patients experiencing chronic pain. ​

scholarly journals The Opioid Crisis Viewed Through the Lens of a Black and White Camera

2020 ◽  
Vol 5 (9) ◽  
Keyword(s):  
United States ◽  
Racial Disparities ◽  
Health Care Disparities ◽  
Cognitive Biases ◽  
Historical Review ◽  
The United States ◽  
Regulatory Control ◽  
Opioid Epidemic ◽  
Opioid Use ◽  
Access To Treatment

The United States’ opioid epidemic is a national public health emergency. As opioid use has not been shielded from health care disparities furthered by economic, gender, race, and sex biases, discrepancies in the rates of abuse and access to treatment exist among non-white minorities. This narrative literature review is an evaluation of the literature centered on minority racial disparities in opioid use, abuse, and care in the United States. Racial disparities in prescribing opioid-containing compounds are staggering among non-white individuals. A historical review of opioid regulatory control is offered as an explanation for the cognitive biases demonstrated by clinicians. Governmental regulation is among the polyfactorial roots of racial inequity in the opioid epidemic. Literature describing physician bias and portrayals of racial and sexual disparities in opioid abuse disorders are presented. As part of the national response to this evident disparity, addressing these issues will be an important factor in curbing this epidemic and tools to assist in mitigating these obstacles are presented.

A scoping review of acupuncture insurance coverage in the United States

2020 ◽  
pp. 096452842096421
Author(s):  
Roselle Bleck ◽  
Emma Marquez ◽  
Melanie A Gold ◽  
Carolyn L Westhoff
Keyword(s):  
United States ◽  
Scoping Review ◽  
Insurance Coverage ◽  
Research Priorities ◽  
The United States ◽  
Subject Area ◽  
Published Data ◽  
Opioid Use ◽  
Knowledge Gaps ◽  
The Impact

Background: Increasing access to non-pharmacologic pain management modalities, including acupuncture, has the potential to reduce opioid overuse. A lack of insurance coverage for acupuncture could present a barrier for both patients and providers. The objective of this scoping review was to assess the existing literature on acupuncture insurance coverage in the United States and to identify knowledge gaps and research priorities. Methods: We utilized the Arksey and O’Malley framework to guide our scoping review methodology. We followed a pre-determined study protocol for the level-one abstract and level-two full text screenings. We synthesized information into subject-area domains and identified knowledge gaps. Results: We found a lack of published data on acupuncture coverage in 44 states, especially in the Midwest and the South. Where data were available, a large proportion of acupuncture users did not have insurance coverage. Consumer demand, state mandates, and efforts to reduce opioid use were motivations to cover acupuncture. Licensed acupuncturists were less likely to be reimbursed and were reimbursed at lower rates compared to physicians. Reported barriers encountered when implementing coverage included a lack of providers, challenges determining when to offer non-pharmacologic treatments, and a lack of evidence for clinical efficacy and cost-effectiveness. Conclusion: We found a lack of recent publications and data comparing regional coverage in the United States. A key challenge is that commercial insurance plan data are not in the public domain. Further research should assess insurance coverage implementation for acupuncture and measure the impact of policy changes on acupuncture utilization and rates of opioid overuse.

The opioid epidemic

2017 ◽  
Vol 52 (2) ◽  
pp. 196-201 ◽  
Author(s):  
Nitin Chopra ◽  
Lauren H Marasa
Keyword(s):  
United States ◽  
Treatment Options ◽  
The United States ◽  
Opioid Use Disorder ◽  
Treatment Programs ◽  
Opioid Epidemic ◽  
Opioid Use ◽  
Significant Family History ◽  
History Of ◽  
Number Of Treatment

Opioid use disorder is a growing epidemic, with an alarming number of associated deaths. In 2014, in the United States, 18,893 lethal overdoses were related to prescription opioids and 10,574 due to heroin. Despite the growing number of treatment options for substance use disorders, which are chronic, relapsing-remitting conditions, relapse rates remain as high as 91%. In the United States, 7.5 million children reside with at least one patient who abuses drugs or alcohol. Mothers are twice as likely to lose custody of their children. They have higher rates of comorbid abuse and psychopathology and limited social supports. Child service agencies, commonly involved in these scenarios, are often pressured to find permanent placement for children, within an expedited timeframe, inconsistent with the need for sufficient time for recovery and goals of family inclusion and unity. We present the complicated case of a 25-year-old woman with a history of opioid use disorder and depression, who, after being in and out of treatment programs for years, had a lethal overdose. She had a significant family history of addiction and had lost custody of her children. This challenging, but common presentation draws attention to challenges in providing treatment during this opioid epidemic.

scholarly journals Cross-state variation in opioid use disorder among a privately insured nonelderly population in the United States

2020 ◽  
Author(s):  
Bibo Jiang ◽  
Li Wang ◽  
Douglas Leslie
Keyword(s):  
United States ◽  
The United States ◽  
Opioid Use Disorder ◽  
Opioid Epidemic ◽  
Opioid Use ◽  
Prescription Drug Monitoring Programs ◽  
The Us ◽  
State Variation ◽  
Demographic Patterns ◽  
Privately Insured

Abstract Background: Although cross-state variation of the opioid epidemic in the United States are well documented in general, little are known about the epidemic in privately insured individuals. Objectives: To describe cross-state variation in Opioid Use Disorder (OUD) among privately insured individuals in the US for the years 2005-2015 and investigate demographic differences of OUD patients between a group of hard-hit states and the rest states. Methods: The MarketScan Commercial Claims and Encounters database was used to calculate prevalence of opioid use disorder for the 50 states in the US, respectively. We analyzed level and change of OUD prevalence in each state from 2005 to 2015 and identified the states which were affected most by the epidemic. One-sided exact fisher test was used to analyze demographic difference of the epidemic in the hard-hit states and the remaining states. Results: Cross-state variations of the opioid epidemic among privately insured population were substantial, both in terms of severity and acceleration of the epidemic. Demographic patterns of the epidemic were similar across states. The 18-34 age group was the most affected group with the highest prevalence. The 55-64 group experienced the most rapid increase of OUD prevalence, especially in states that suffered most in the epidemic. Conclusions: Results can assist policy makers to design better clinical and policy interventions on the opioid epidemic, especially on privately insured individuals. Drastic increase of OUD prevalence among the 55-64 group might indicate the need to improve prescription drug monitoring programs for chronic pain, especially in states more affected by the epidemic.

scholarly journals The NFL Should Stop Trying to Weed Out Marijuana

2018 ◽  
Vol 5 (4) ◽  
pp. 33-36
Author(s):  
Stephanie Assi
Keyword(s):  
United States ◽  
Drug Testing ◽  
Health And Safety ◽  
Medical Marijuana ◽  
Marijuana Use ◽  
The United States ◽  
Opioid Addiction ◽  
Opioid Epidemic ◽  
Opioid Use ◽  
Medical Marijuana Use

Is the NFL’s drug-testing policy on medical marijuana out of date? In recent years, the United States has seen a rise in opioid addiction and opioid related deaths. The NFL is not immune from the opioid epidemic, as many current and retired players have addressed the troubled paradigm of needing relief from pain caused by years of playing in the NFL, but the increased risks of opioid use to treat said pain. This article addresses the current NFL policy regarding medical marijuana use and how changing this policy could ultimately benefit the health and safety of the NFL players.

scholarly journals Hispanics, Addictions, and the Opioid Epidemic: Brief Report

2019 ◽  
Vol 18 (1) ◽  
pp. 40-43
Author(s):  
Francisco Brenes ◽  
Federico Henriquez
Keyword(s):  
United States ◽  
Health Care ◽  
Health Care Disparities ◽  
Health Care Policy ◽  
The United States ◽  
Health Concern ◽  
Practice Research ◽  
Opioid Overdose ◽  
Opioid Epidemic ◽  
Opioid Use

Opioid addiction is a public health concern. Opioid overdose death rates account for one third to a half of all global substance-related deaths. Opioid mortality rates increased nearly fivefold in the United States between 1999 and 2016. Recent research has found health care disparities in the United States among minority populations with opioid use disorder, particularly Hispanics. Current literature also suggests that a number of social and cultural factors, including the stigma linked to mental illness and treatment in the Hispanic culture, may further negatively contribute to the problem. This brief report pays close attention to the opioid epidemic in the United States and addresses issues related to the crisis among Hispanics. Recommendations for clinical practice, research, and health care policy are also discussed.

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