Increased Risk of Opioid Overdose Death Following Cold Weather

Objectives. To examine trends in opioid overdose deaths by race/ethnicity from 2018 to 2019 across 67 HEALing Communities Study (HCS) communities in Kentucky, New York, Massachusetts, and Ohio. Methods. We used state death certificate records to calculate opioid overdose death rates per 100 000 adult residents of the 67 HCS communities for 2018 and 2019. We used Poisson regression to calculate the ratio of 2019 to 2018 rates. We compared changes by race/ethnicity by calculating a ratio of rate ratios (RRR) for each racial/ethnic group compared with non-Hispanic White individuals. Results. Opioid overdose death rates were 38.3 and 39.5 per 100 000 for 2018 and 2019, respectively, without a significant change from 2018 to 2019 (rate ratio = 1.03; 95% confidence interval [CI] = 0.98, 1.08). We estimated a 40% increase in opioid overdose death rate for non-Hispanic Black individuals (RRR = 1.40; 95% CI = 1.22, 1.62) relative to non-Hispanic White individuals but no change among other race/ethnicities. Conclusions. Overall opioid overdose death rates have leveled off but have increased among non-Hispanic Black individuals. Public Health Implications. An antiracist public health approach is needed to address the crisis of opioid-related harms. (Am J Public Health. Published online ahead of print September 9, 2021:e1–e4. https://doi.org/10.2105/AJPH.2021.306431 )

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Improving harm reduction with a naloxone intervention in primary care to prescribe and educate a support person

Journal of Opioid Management ◽

10.5055/jom.2021.0621 ◽

2021 ◽

Vol 17 (2) ◽

pp. 109-113

Author(s):

Julienne K. Kirk, PharmD, CDE, BCPS ◽

Matthew Q. Tran, PharmD ◽

Samantha Pelc, PharmD ◽

Katherine G. Moore, PharmD, BCPS, BCACP

Keyword(s):

Primary Care ◽

High Risk ◽

Family Medicine ◽

Quality Improvement Intervention ◽

Opioid Overdose ◽

Naloxone Administration ◽

Support Person ◽

High Risk Patients ◽

Increased Risk ◽

Risk Patients

Objective: To determine whether a pharmacist-led intervention would increase the number of naloxone prescriptions and naloxone administration education in a primary care family medicine setting.Design: Prospective quality improvement intervention in an academic family medicine clinic.Methods: We surveyed providers about naloxone knowledge, prescribing habits, and prescribing barriers. We identified patients on chronic opioid therapy, through electronic health records for the year 2019. Overdose risk categories based upon morphine milligram equivalent doses and concomitant benzodiazepine use were used to determine patients who met criteria for naloxone. Pharmacists phoned qualified patients to discuss overdose risk and naloxone benefits. Patients who accepted naloxone prescriptions used their local pharmacy through a department-approved standing order set.Results: From the survey results, there were 47 of 54 provider responses, and the majority noted that they do not routinely prescribe naloxone in high-risk patients. The predominant barriers were lack of time during visit and naloxone administration education. The population of patients from chart review included 93 high-risk patients with a mean age of 58 years. During the time of intervention, 71 patients remained eligible for naloxone coprescribing. Of the patients contacted, 29 (40 percent) accepted the intervention prescription, and subsequently, 22 picked up their prescription from the pharmacy. Sixteen received counseling with a support person. Twelve patients had naloxone already at home, and two received counseling with a support person.Conclusion: The naloxone prescribing intervention is achievable. The results of this intervention support identifying patients at increased risk of opioid overdose and offer education of a support person for naloxone in a large academic family medicine clinic.

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Race, Adolescent Socioeconomic Status, and Lifetime Non-Medical Use of Prescription Painkillers: Evidence from the National Longitudinal Study of Adolescent to Adult Health

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph182312289 ◽

2021 ◽

Vol 18 (23) ◽

pp. 12289

Author(s):

Amy Ehntholt ◽

Roman Pabayo ◽

Lisa Berkman ◽

Ichiro Kawachi

Keyword(s):

Socioeconomic Status ◽

Longitudinal Study ◽

Ethnic Differences ◽

Early Life ◽

Family Income ◽

Opioid Overdose ◽

Adult Health ◽

National Longitudinal Study ◽

Increased Risk ◽

Racial Ethnic

The misuse of prescription painkillers is a major contributor to the ongoing drug overdose epidemic. This study investigated variability in non-medical use of prescription painkillers (NMUPP) by race and early-life socioeconomic status (SES) in a sample now at increased risk for opioid overdose. Data from two waves of the National Longitudinal Study of Adolescent to Adult Health (n = 11,602) were used to calculate prevalence of reported NMUPP by Wave 4 (2008; mean age 28), and to assess variation by race and by equivalized household family income at Wave 1 (1994/5). Predicted values for prevalence of NMUPP were modelled, adjusting for age, sex, parental education, and region. Race and SES in adolescence were associated with later reported NMUPP. A gradient was seen in prevalence by SES (adjusted: family income quartile 1 = 13.3%; quartile 2 = 13.8%; quartile 3 = 14.8%; quartile 4 = 16.0%; trend p-value = 0.007). Prevalence was higher among males. Racial/ethnic differences in prevalence were seen (non-Hispanic white (NHW) = 18.5%; non-Hispanic black (NHB) = 5.8%; Hispanic = 10.5%; Other = 10.0%). SES differences were less pronounced upon stratification, with trend tests significant only among females (p = 0.004), and marginally significant among Hispanic males (p = 0.06). Early-life SES was associated with reported lifetime NMUPP: the higher the family income in adolescence, the greater the likelihood of NMUPP by young adulthood. Variations in NMUPP by income paled in comparison with racial/ethnic differences. Results point to a possible long-enduring association between SES and NMUPP, and a need to examine underlying mechanisms.

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High Rate of Fatal Overdose After Release from Prison In BC, Canada: A Data Linkage Study

International Journal for Population Data Science ◽

10.23889/ijpds.v5i5.1606 ◽

2020 ◽

Vol 5 (5) ◽

Author(s):

Stuart A Kinner ◽

Wenqi Gan ◽

Amanda Slaunwhite

Keyword(s):

Risk Factors ◽

Target Population ◽

Linkage Study ◽

High Rate ◽

Physical And Mental Health ◽

Overdose Death ◽

Fatal Overdose ◽

Increased Risk ◽

The Impact ◽

Release From Prison

IntroductionThe province of BC, Canada is in the grips of a sustained overdose epidemic. People released from prison are at increased risk of fatal drug overdose, but the impact of the overdose epidemic on mortality after release from prison in BC is poorly understood. Few studies have been able to examine risk factors for overdose death in this population. Objectives and ApproachWe aimed to (a) measure risk of overdose-related and all-cause death in different time periods after release from prison; and (b) identify risk factors for overdose-related and all-cause death. In a random 20% sample of the population of BC, Canada, we identified those released from prison 2015-2017 and examined linked health and correctional records for this cohort. ResultsOf 6106 persons released from prison 2015-2017, 77 (1.3%) died from any cause and 48 (0.8%) died from overdose 2015-2017. The incidence of all-cause death was 16.1 (95%CI 13.7-18.8) per 1000 person years, and the incidence of overdose death was 11.2 (95%CI 9.2-13.5) per 1000 person years. Risk factors for overdose death included a history of 3 or more incarcerations (HR=3.00, 95%CI 1.67-5.39), co-occurring substance use disorder and mental illness (HR=4.73, 95%CI 2.94-7.62), chronic physical morbidity (HR=3.10, 95%CI 1.97-4.88), and being dispensed benzodiazepines (HR=3.31, 95%CI 2.27-4.84) or opioids for pain (HR=6.77, 95%CI 3.86-11.89). The incidence of fatal overdose was significantly higher in the first two weeks post-release than at any other time during follow-up. ConclusionPeople released from prison in BC are at markedly increased risk of preventable death, mainly due to overdose. As such, people transitioning from prison to the community should be a key target population for overdose prevention efforts. To be maximally effective, these efforts must go beyond provision of methadone and naloxone on release, to consider physical and mental health comorbidities, and psychosocial disadvantage.

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Data quality considerations when using county-level opioid overdose death rates to inform policy and practice: A reply

Drug and Alcohol Dependence ◽

10.1016/j.drugalcdep.2019.107550 ◽

2019 ◽

Vol 204 ◽

pp. 107550

Author(s):

Chandler B. McClellan

Keyword(s):

Data Quality ◽

Opioid Overdose ◽

County Level ◽

Policy And Practice ◽

Death Rates ◽

Overdose Death

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Drug Use, Homelessness and Health: Responding to the Opioid Overdose Crisis with Housing and Harm Reduction Services

10.21203/rs.3.rs-507032/v1 ◽

2021 ◽

Author(s):

katrina milaney

Keyword(s):

Drug Use ◽

Harm Reduction ◽

Housing Instability ◽

Opioid Overdose ◽

Opioid Use ◽

Chi Square ◽

Increased Risk ◽

Reported Data ◽

Structural Inequities ◽

Hospital Use

Abstract Background Canada is in the midst of an opioid overdose crisis and Alberta has one of the highest opioid use rates across the country. Populations made vulnerable through structural inequities who also use opioids, such as those who are unstably housed, are at an increased risk of experiencing harms associated with opioid use. The main purpose of this study was to explore if there was an association between unstable housing and hospital use for people who use opioids. Methods Analysis utilized self-reported data from the Alberta Health and Drug Use Survey which surveyed 813 Albertans in three cities. Hospital use was modeled using a logistic regression with our primary variable of interest being housing unstable status. Chi square tests were conducted between hospital use and variables associated with demographics, characteristics of drug use, health characteristics, and experiences of receiving services to establish model inclusion. Results Results revealed a significant association between housing instability and hospital use.with unstably housed individuals twice as likely torequire hospital care. Conclusions Results highlight the importance of concurrently addressing housing instability alongside the provision of harm reduction services such assafe supply and supervised consumption sites. These findings have significant implications for policy and policymakers during the opioid overdose epidemic, and provide a foundation for future areas of research.

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Opioid Overdose Education, Prevention, and Management (DRAFT)

10.1093/med/9780190265366.003.0013 ◽

2018 ◽

Cited By ~ 1

Author(s):

Bernd Wollschlaeger

Keyword(s):

The United States ◽

Opioid Use Disorder ◽

Opioid Overdose ◽

Opioid Use ◽

Death Rates ◽

Overdose Prevention ◽

Overdose Death ◽

Good Samaritan ◽

Opioid Deaths ◽

Good Samaritan Laws

In reviewing the elements of opioid overdose education, prevention, and management, this chapter focuses particularly on practical interventions that are available and deserve advocacy; e.g., provision of naloxone to those with opioid use disorder and to possible first responders. It moves from a discussion of the epidemiology of opioid deaths to the more individual topic of patient risk for overdose. Prophylactic interventions in the form of education of the patient’s family and friends, and agreements for treatment with informed consent are described. There follows a discussion of management of the opioid poisoning itself, including use/distribution of naloxone injection. Two figures are included: drug overdose death rates in the United States (2014); a map describing the current states with naloxone or “good Samaritan” laws impacting opioid overdose management. A text box with resources includes directions for initiation of community overdose prevention and intervention schemes.

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Development of a Training Program for Law Enforcement K9 Handlers to Administer Naloxone

Journal of the American Animal Hospital Association ◽

10.5326/jaaha-ms-6965 ◽

2020 ◽

Vol 56 (4) ◽

pp. 197-205

Author(s):

Ashley Mitek ◽

Maureen McMichael ◽

Brad Weir ◽

Michael Smith ◽

Danielle Schneider ◽

...

Keyword(s):

Law Enforcement ◽

Training Program ◽

Training Session ◽

Vital Signs ◽

Signs And Symptoms ◽

The United States ◽

Comfort Level ◽

Opioid Overdose ◽

Increased Risk ◽

Level Monitoring

ABSTRACT As the opioid epidemic continues across the United States, law enforcement K9s (LEK9s) are at increased risk of accidental exposure and overdose. This study evaluated a novel training program teaching handlers to administer naloxone to their LEK9 in the event of an overdose. Seventy-five LEK9 handlers from a governmental agency attended a naloxone training session. A presurvey given to the handlers evaluated their knowledge of opioid overdose in LEK9s and their confidence administering naloxone. Officers were educated via a PowerPoint presentation about naloxone and how to administer it to their LEK9. A postsurvey evaluated changes in their knowledge and confidence as a result of the presentation. Sixty-two presurveys and 47 postsurveys were completed. Nearly all handlers had never given their LEK9 an intramuscular or intranasal injection. Most handlers were not comfortable monitoring their LEK9’s vital signs for an opioid overdose. After the training, handlers demonstrated a mild increase in comfort level administering intramuscular and intranasal naloxone (15 and 14% increase, respectively). Comfort level monitoring vital signs and symptoms of an opioid overdose increased 38 and 32%, respectively. Handlers may not be fully prepared to assess and treat their LEK9 and may benefit from a targeted training program teaching them to administer naloxone.

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