scholarly journals Prescription opioid overdose and adverse effect hospitalisations among injured workers in eight states (2010–2014)

2020 ◽  
Vol 77 (7) ◽  
pp. 439-445 ◽  
Author(s):  
Jeanne M Sears ◽  
Sheilah Hogg-Johnson ◽  
Ryan A Sterling ◽  
Deborah Fulton-Kehoe ◽  
Gary M Franklin
Keyword(s):  
Adverse Effect ◽  
South Carolina ◽  
Fatal Outcome ◽  
State Level ◽  
Healthcare Research ◽  
Injured Workers ◽  
Prescription Opioid ◽  
Opioid Overdose ◽  
Prescribing Practices ◽  
Discharge Data

ObjectiveHigh-risk opioid prescribing practices in workers’ compensation (WC) settings are associated with excess opioid-related morbidity, longer work disability and higher costs. This study characterises the burden of prescription opioid-related hospitalisations among injured workers.MethodsHospital discharge data for eight states (Arizona, Colorado, Michigan, New Jersey, New York, South Carolina, Utah and Washington) were obtained from the State Inpatient Databases, Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality. We calculated 5-year (2010–2014) average annual rates of prescription opioid overdose/adverse effect (AE) hospitalisations. Injured workers were identified using payer (WC) and external cause codes.ResultsState-level average annual prescription opioid overdose/AE hospitalisation rates ranged from 0.3 to 1.2 per 100 000 employed workers. Rates for workers aged ≥65 years old were two to six times the overall rates. Among those hospitalised with prescription opioid overdose/AEs, injured workers were more likely than other inpatients to have a low back disorder diagnosis, and less likely to have an opioid dependence/abuse or cancer diagnosis, or a fatal outcome. Averaged across states, WC was the primary expected payer for <1% of prescription opioid overdose/AE hospitalisations vs 6% of injury hospitalisations.ConclusionsPopulation-based estimates of prescription opioid morbidity are almost nonexistent for injured workers; this study begins to fill that gap. Rates for injured workers increased markedly with age but were low relative to inpatients overall. Research is needed to assess whether WC as payer adequately identifies work-related opioid morbidity for surveillance purposes, and to further quantify the burden of prescription opioid-related morbidity.

scholarly journals Opioid Overdose Hospitalization Trajectories in States With and Without Opioid-Dosing Guidelines

2019 ◽  
Vol 134 (5) ◽  
pp. 567-576
Author(s):  
Jeanne M. Sears ◽  
Deborah Fulton-Kehoe ◽  
Beryl A. Schulman ◽  
Sheilah Hogg-Johnson ◽  
Gary M. Franklin
Keyword(s):  
South Carolina ◽  
Negative Binomial ◽  
State Level ◽  
Healthcare Research ◽  
Prescription Opioid ◽  
High Dose ◽  
Opioid Overdose ◽  
Prescribing Practices ◽  
Health Crisis ◽  
Opioid Prescribing

Objectives: High-risk opioid-prescribing practices contribute to a national epidemic of opioid-related morbidity and mortality. The objective of this study was to determine whether the adoption of state-level opioid-prescribing guidelines that specify a high-dose threshold is associated with trends in rates of opioid overdose hospitalizations, for prescription opioids, for heroin, and for all opioids. Methods: We identified 3 guideline states (Colorado, Utah, Washington) and 5 comparator states (Arizona, California, Michigan, New Jersey, South Carolina). We used state-level opioid overdose hospitalization data from 2001-2014 for these 8 states. Data were based on the State Inpatient Databases and provided by the Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality, via HCUPnet. We used negative binomial panel regression to model trends in annual rates of opioid overdose hospitalizations. We used a multiple-baseline difference-in-differences study design to compare postguideline trends with concurrent trends for comparator states. Results: For each guideline state, postguideline trends in rates of prescription opioid and all opioid overdose hospitalizations decreased compared with trends in the comparator states. The mean annual relative percentage decrease ranged from 3.2%-7.5% for trends in rates of prescription opioid overdose hospitalizations and from 5.4%-8.5% for trends in rates of all opioid overdose hospitalizations. Conclusions: These findings provide preliminary evidence that opioid-dosing guidelines may be an effective strategy for combating this public health crisis. Further research is needed to identify the individual effects of opioid-related interventions that occurred during the study period.

Economic Conditions and Drug and Opioid Overdose Deaths

2017 ◽  
Vol 76 (4) ◽  
pp. 462-477 ◽  
Author(s):  
Ezequiel Brown ◽  
George L. Wehby
Keyword(s):  
Drug Overdose ◽  
Fixed Effects ◽  
House Prices ◽  
Insurance Coverage ◽  
House Price ◽  
State Level ◽  
Economic Conditions ◽  
Prescription Opioid ◽  
Opioid Overdose ◽  
Overdose Deaths

We examine the effects of state-level economic conditions including unemployment rates, median house price, median household income, insurance coverage, and annual and weekly work time on deaths on drug overdose deaths including from opioids and prescription opioids between 1999 and 2014. We employ difference-in-differences estimation controlling for state and year fixed effects, state-specific time trends, and demographic characteristics. Drug overdose deaths significantly declined with higher house prices, an effect driven by reduction in prescription-opioid mortality, by nearly 0.17 deaths per 100,000 (~4%) with a $10,000 increase in median house price. House price effects were more pronounced and only significant among males, non-Hispanic Whites, and individuals younger 45 years. Other economic indicators had insignificant effects. Our findings suggest that economic downturns that substantially reduce house prices such as the Great Recession can increase opioid-related deaths, suggesting that efforts to control access to such drugs should especially intensify during these periods.

scholarly journals Changes in Characteristics of Opioid Overdose Death Trends during the COVID-19 Pandemic

2021 ◽  
Author(s):  
Catherine DiGennaro ◽  
Gian-Gabriel P. Garcia ◽  
Erin J. Stringfellow ◽  
Sarah Wakeman ◽  
Mohammad S. Jalali
Keyword(s):  
Case Fatality ◽  
State Level ◽  
Prescription Opioid ◽  
Mortality Data ◽  
Opioid Overdose ◽  
Mortality Trends ◽  
Death Rates ◽  
Individual Level ◽  
Great Heterogeneity ◽  
Black Residents

AbstractBackground and AimsThere are limited reports analyzing opioid overdose (OD) mortality data during the COVID-19 pandemic. There is also great heterogeneity in outcomes across states, necessitating assessments of the effects of COVID-19 on OD deaths on a state-by-state level. This report aims to analyze overall trends in OD deaths in Massachusetts during COVID-19.DesignUsing individual-level death records in Massachusetts, we identified and analyzed OD mortality trends during the COVID-19 pandemic as compared to 2018 and 2019. We analyzed the period between March 24 (stay-at-home order in 2020) and August 11 (latest reliable data). We also estimated the correlation between OD deaths and COVID-19 case fatality rates at the county level.SettingMassachusetts.ParticipantsA total of 2,342 OD deaths were analyzed.MeasurementsThe outcomes studied were OD deaths and COVID-19 case fatality rates.FindingsOD deaths involving cocaine and amphetamines increased from 2019 to 2020, by 20% (276 vs. 330; P<0.01) and 79% (33 vs. 59; P<0.01), respectively, but were steady from 2018 to 2019. Heroin’s presence continued to decrease (238 in 2018, 161 in 2019, 102 in 2020; P<0.001); however, fentanyl was present in more than 90% of OD deaths, reflecting its continued domination of the illicit opioid supply in Massachusetts. Prescription opioid presence was stable. 79% of OD decedents were White and 6% were Black in 2019, as compared to 74% and 10% in 2020 (P=0.01). We found no significant correlation between COVID-19 case fatality and OD death rates.ConclusionsIncreased deaths involving stimulants and alcohol reflect concerning trends in the era of COVID-19. Rising OD death rates among Black residents underscore that interventions focused on racial equity are necessary. Surveillance efforts must utilize up-to-date data to measure COVID-19 impacts on OD death and respond to imminent threats in real time.

scholarly journals Soil Carbon Regulating Ecosystem Services in the State of South Carolina, USA

Land ◽  
2021 ◽  
Vol 10 (3) ◽  
pp. 309
Author(s):  
Elena A. Mikhailova ◽  
Hamdi A. Zurqani ◽  
Christopher J. Post ◽  
Mark A. Schlautman ◽  
Gregory C. Post ◽  
...  
Keyword(s):  
South Carolina ◽  
Ecosystem Services ◽  
Soil Carbon ◽  
Soil Depth ◽  
State Level ◽  
The United States ◽  
The State ◽  
Soil C ◽  
Low Country ◽  
Pee Dee

Sustainable management of soil carbon (C) at the state level requires valuation of soil C regulating ecosystem services (ES) and disservices (ED). The objective of this study was to assess the value of regulating ES from soil organic carbon (SOC), soil inorganic carbon (SIC), and total soil carbon (TSC) stocks, based on the concept of the avoided social cost of carbon dioxide (CO2) emissions for the state of South Carolina (SC) in the United States of America (U.S.A.) by soil order, soil depth (0–200 cm), region and county using information from the State Soil Geographic (STATSGO) database. The total estimated monetary mid-point value for TSC in the state of South Carolina was $124.36B (i.e., $124.36 billion U.S. dollars, where B = billion = 109), $107.14B for SOC, and $17.22B for SIC. Soil orders with the highest midpoint value for SOC were: Ultisols ($64.35B), Histosols ($11.22B), and Inceptisols ($10.31B). Soil orders with the highest midpoint value for SIC were: Inceptisols ($5.91B), Entisols ($5.53B), and Alfisols ($5.0B). Soil orders with the highest midpoint value for TSC were: Ultisols ($64.35B), Inceptisols ($16.22B), and Entisols ($14.65B). The regions with the highest midpoint SOC values were: Pee Dee ($34.24B), Low Country ($32.17B), and Midlands ($29.24B). The regions with the highest midpoint SIC values were: Low Country ($5.69B), Midlands ($5.55B), and Pee Dee ($4.67B). The regions with the highest midpoint TSC values were: Low Country ($37.86B), Pee Dee ($36.91B), and Midlands ($34.79B). The counties with the highest midpoint SOC values were Colleton ($5.44B), Horry ($5.37B), and Berkeley ($4.12B). The counties with the highest midpoint SIC values were Charleston ($1.46B), Georgetown ($852.81M, where M = million = 106), and Horry ($843.18M). The counties with the highest midpoint TSC values were Horry ($6.22B), Colleton ($6.02B), and Georgetown ($4.87B). Administrative areas (e.g., counties, regions) combined with pedodiversity concepts can provide useful information to design cost-efficient policies to manage soil carbon regulating ES at the state level.

The South Carolina Digital Watershed: End-to-End Support for Real-Time Management of Water Resources

2010 ◽  
Vol 6 (1) ◽  
pp. 970868 ◽  
Author(s):  
G. W. Eidson ◽  
S. T. Esswein ◽  
J. B. Gemmill ◽  
J. O. Hallstrom ◽  
T. R. Howard ◽  
...  
Keyword(s):  
South Carolina ◽  
Water Resources ◽  
Real Time ◽  
Time Management ◽  
State Level ◽  
Data Streaming ◽  
The South ◽  
Core System ◽  
End To End

Water resources are under unprecedented strain. The combined effects of population growth, climate change, and rural industrialization have led to greater demand for an increasingly scarce resource. Ensuring that communities have adequate access to water—an essential requirement for community health and prosperity—requires finegrained management policies based on real-time in situ data, both environmental and hydrological. To address this requirement at the state level, we have developed the South Carolina Digital Watershed, an end-to-end system for monitoring water resources. In this paper, we describe the design and implementation of the core system components: (i) in situ sensing hardware, (ii) collection and uplink facilities, (iii) data streaming middleware, and (iv) back-end repository and presentation services. We conclude by discussing key organizational and technical challenges encountered during the development process.

scholarly journals Evaluation of a Medicaid performance improvement project to reduce high-dose opioid prescriptions

2022 ◽  
Vol 22 (1) ◽  
Author(s):  
Daniel M. Hartung ◽  
Jonah Geddes ◽  
Sara E. Hallvik ◽  
P. Todd Korthuis ◽  
Luke Middleton ◽  
...  
Keyword(s):  
Performance Improvement ◽  
Emergency Department Visits ◽  
Prescription Opioid ◽  
High Dose ◽  
Opioid Overdose ◽  
Opioid Use ◽  
Improvement Project ◽  
Opioid Prescribing ◽  
Percentage Points ◽  
Prescription Opioid Use

Abstract Background In 2015, Oregon’s Medicaid program implemented a performance improvement project to reduce high-dose opioid prescribing across its 16 coordinated care organizations (CCOs). The objective of this study was to evaluate the effect of that program on prescription opioid use and outcomes. Methods Using Medicaid claims data from 2014 to 2017, we conducted interrupted time-series analyses to examine changes in the prescription opioid use and overdose rates before (July 2014 to June 2015) and after (January 2016 to December 2017) implementation of Oregon’s high-dose policy initiative (July 2015 to December 2015). Prescribing outcomes were: 1) total opioid prescriptions 2) high-dose [> 90 morphine milligram equivalents per day] opioid prescriptions, and 3) proportion of opioid prescriptions that were high-dose. Opioid overdose outcomes included emergency department visits or hospitalizations that involved an opioid-related poisoning (total, heroin-involved, non-heroin involved). Analyses were performed at the state and CCO level. Results There was an immediate reduction in high dose opioid prescriptions after the program was implemented (− 1.55 prescription per 1000 enrollee; 95% CI − 2.26 to − 0.84; p < 0.01). Program implementation was also associated with an immediate drop (− 1.29 percentage points; 95% CI − 1.94 to − 0.64 percentage points; p < 0.01) and trend reduction (− 0.23 percentage point per month; 95% CI − 0.33 to − 0.14 percentage points; p < 0.01) in the monthly proportion of high-dose opioid prescriptions. The trend in total, heroin-involved, and non-heroin overdose rates increased significantly following implementation of the program. Conclusions Although Oregon’s high-dose opioid performance improvement project was associated with declines in high-dose opioid prescriptions, rates of opioid overdose did not decrease. Policy efforts to reduce opioid prescribing risks may not be sufficient to address the growing opioid crisis.

scholarly journals Identifying appropriate outcomes to help evaluate the impact of the Canadian Guideline for Safe and Effective Use of Opioids for Non-Cancer Pain

2019 ◽  
Author(s):  
Michael Allen ◽  
Beth Sproule ◽  
Peter MacDougall ◽  
Andrea Furlan ◽  
Laura Murphy ◽  
...  
Keyword(s):  
Cancer Pain ◽  
Patient Outcomes ◽  
Opioid Therapy ◽  
Data Sources ◽  
Prescription Opioid ◽  
Advisory Group ◽  
Opioid Overdose ◽  
Canadian Guideline ◽  
Effective Use ◽  
The Impact

Abstract Background: The Canadian Guideline for Safe and Effective Use of Opioids for Chronic Non-Cancer Pain (COG) was developed in response to increasing rates of opioid-related hospital visits and deaths in Canada, and uncertain benefits of opioids for chronic non-cancer pain (CNCP). Following publication, we developed a list of evaluable outcomes to assess the impact of this guideline on practice and patient outcomes . Methods: A working group at the National Pain Centre at McMaster University used a modified Delphi process to construct a list of clinical and patient outcomes important in assessing the uptake and application of the COG. An advisory group then reviewed this list to determine the relevance and feasibility of each outcome, and identified potential data sources. This feedback was reviewed by the National Faculty for the Guideline, and a National Advisory Group that included the creators of the COG, resulting in the final list of 5 priority outcomes. Results: Five outcomes were judged clinically important and feasible to measure: 1) Effects of opioids for CNCP on quality of life, 2) Assessment of patient’s risk of addiction before starting opioid therapy, 3) Monitoring patients on opioid therapy for aberrant drug-related behaviour, 4) Mortality rates associated with prescription opioid overdose and 5) Use of treatment agreements with patients before initiating opioid therapy for CNCP. Data sources for these outcomes included patient’s medical charts, e-Opioid Manager, prescription monitoring programs and administrative databases. Conclusion: Measuring the impact of best practice guidelines is infrequently done. Future research should consider capturing the five outcomes identified in this study to evaluate the impact of the COG in promoting evidence-based use of opioids for CNCP.

scholarly journals The Economic Underpinnings of the Drug Epidemic

2019 ◽  
Author(s):  
Nathan Seltzer
Keyword(s):  
Labor Market ◽  
Labor Markets ◽  
Drug Overdose ◽  
Manufacturing Sector ◽  
State Level ◽  
Opioid Overdose ◽  
Transformative Change ◽  
Drug Deaths ◽  
Overdose Deaths ◽  
The U.S

U.S. labor markets have experienced transformative change over the past half century. Spurred on by global economic change, robotization, and the decline of labor unions, state labor markets have shifted away from an occupational regime dominated by the production of goods to one characterized by the provision of services. Prior studies have proposed that deterioration of employment opportunities may be associated with the rise of substance use disorders and drug overdose deaths, yet no clear link between changes in labor market dynamics in the U.S. manufacturing sector and drug overdose deaths has been established. Using restricted-use vital registration records between 1999-2017 that comprise over 700,000 drug deaths, I test two questions. First, what is the association between manufacturing decline and drug and opioid overdose mortality rates? Second, how much of the increase in these drug-related outcomes can be accounted for by manufacturing decline? The findings provide strong evidence that restructuring of the U.S. labor market has played an important upstream role in the current drug crisis. Up to 77,000 overdose deaths for men and up to 40,000 overdose deaths for women are attributable to the decline of state-level manufacturing over this nearly two-decade period. These results persist in models that adjust for other social, economic, and policy trends changing at the same time, including the supply of prescription opioids. Critically, the findings signal the value of policy interventions that aim to reduce persistent economic precarity experienced by individuals and communities, especially the economic strain placed upon the middle class.

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