Dispensing Naloxone Without a Prescription: Survey Evaluation of Ohio Pharmacists

2018 ◽  
Vol 32 (4) ◽  
pp. 412-421 ◽  
Author(s):  
Erin L. Thompson ◽  
P. S. S. Rao ◽  
Christopher Hayes ◽  
Catherine Purtill
Keyword(s):  
Social Stigma ◽  
Mail Survey ◽  
The United States ◽  
Perceived Barriers ◽  
Opioid Overdose ◽  
Comfort Perception ◽  
Control And Prevention ◽  
Survey Evaluation ◽  
E Mail ◽  
Overdose Deaths

Background: The Centers for Disease Control and Prevention (CDC) reports a 200% escalation in the rate of opioid overdose deaths in the United States. Unfortunately, Ohio has been deemed the epicenter of the nation’s opioid epidemic. In 2015, Ohio passed a bill that permits a pharmacist to distribute naloxone without a prescription. Objectives: This survey was aimed to discover pharmacists’ knowledge of naloxone and Ohio law, perceived barriers that may prohibit naloxone dispensing, and Ohio pharmacists’ general confidence, comfort, perception, and experience dispensing naloxone per physician protocol. Methods: Pharmacists’ knowledge of naloxone and Ohio law pertaining to dispensing naloxone; perceived barriers to naloxone distribution; and overall experience, willingness, comfort, and perceptions of personally supplying naloxone were assessed using multiple-choice and Likert-type scale questions through an e-mail survey. Results: Overall, Ohio pharmacists were knowledgeable about naloxone and displayed confidence in their training and ability to provide patient education on naloxone. Pharmacists were less certain about Ohio law pertaining to naloxone distribution, especially those who have been in practice longer. Pharmacists indicated several barriers to dispensing naloxone and the need for more training. Younger pharmacists were more likely to report a concern with clientele who would frequent their pharmacy and moral and ethical concerns as barriers to dispensing naloxone. Conclusion: Additional educational programs should be delivered to Ohio pharmacists to inform them of the state law and policies. Continuing education programs that review substance abuse and attempt to reduce social stigma may assist with increasing naloxone distribution to those in need, especially, if directed toward younger pharmacists in Ohio.

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.

Preparing pharmacists to increase naloxone dispensing within community pharmacies under the Pennsylvania standing order

2020 ◽  
Author(s):  
Heather M Santa ◽  
Samira G Amirova ◽  
Daniel J Ventricelli ◽  
George E Downs ◽  
Alexandra A Nowalk ◽  
...  
Keyword(s):  
Community Pharmacists ◽  
The United States ◽  
Health Concern ◽  
Community Pharmacies ◽  
Opioid Overdose ◽  
Patient Counseling ◽  
Opioid Use ◽  
Overdose Prevention ◽  
Standing Order ◽  
Overdose Deaths

Abstract Purpose Opioid misuse and overdose deaths remain a public health concern in the United States. Pennsylvania has one of the highest rates of opioid overdose deaths in the country, with Philadelphia County’s being 3 times higher than the national average. Despite several multimodal interventions, including use of SBIRT (screening, brief intervention, and referral to treatment) methods and naloxone distribution, the rate of overdose deaths remains high. Methods To gain insights on strategies for improving access to naloxone and naloxone distribution by pharmacists in Philadelphia County, a study was conducted in 11 community pharmacies (chain and independent) in Philadelphia. Twenty-four pharmacists were recruited and completed SBIRT and naloxone trainings. Each pharmacy elected to have at least 1 pharmacy champion who received additional training on and helped develop pharmacy site–specific naloxone dispensing protocols. Results Pre-post survey results showed a reduction in stigmatizing attitudes regarding naloxone dispensing and an increase in pharmacists’ understanding of the standing order and appropriate naloxone use. There was an increase in pharmacists’ self-reported confidence in their ability to appropriately identify, discuss, and dispense naloxone to patients. All pharmacies increased their average monthly dispensing rate following protocol implementation. Conclusion Pharmacists who received both trainings were more likely to change naloxone dispensing practices, leading to an overall increase in naloxone dispensing by community pharmacists. The study addressed overall gaps in pharmacists’ knowledge, reduced stigma, and prepared pharmacists to address opioid use and overdose prevention with their patients. The described pharmacist-led patient counseling and intervention service for overdose prevention may be explored as a model for other community pharmacies to adopt to improve naloxone dispensing and similar interventions to reduce overdose deaths.

“A Life Lived”: Collective Memory and White Racial Framing in Digital Opioid Overdose Obituaries

2020 ◽  
Vol 47 (4) ◽  
pp. 320-337
Author(s):  
Kevin Revier
Keyword(s):  
Predominantly White ◽  
Collective Memory ◽  
News Media ◽  
Qualitative Content Analysis ◽  
The United States ◽  
Opioid Overdose ◽  
Digital Platforms ◽  
Opioid Crisis ◽  
Overdose Deaths ◽  
Racial Framing

With a rise in overdose deaths in the United States, opioid awareness has come in a variety of ways. One of these, as reporters suggest, is obituary writing. Obituaries are considered in news media as offering “brutally frank” depictions of addiction that “chronicle the toll of heroin.” Moreover, obituary sharing by parents and loved ones has increasingly taken place on digital platforms, memorial websites expanding the visibility of overdose death while facilitating the building of virtual grief communities. Not solely commemorating individual loss, obituaries thus contain symbolic power—they reflect dominant social values and shape collective memory. As such, overdose obituaries inform how opioid crisis is framed, represented, and addressed. From a qualitative content analysis of 533 opioid-related U.S. obituaries published on Legacy.com and ObitTree.com , I find that while obituaries reduce stigma associated with drug use, addiction, and overdose, they primarily tell white tales of addiction. In affording a white racial framing of drug addiction, obituary writing corresponds with a larger whitewashing of the opioid crisis while implicitly constructing symbolic boundaries between those memorialized, who are predominantly white and middle-class, and those who are deemed as raced and classed Others. Such storytelling, particularly when popularized in news media and made visible on digital platforms, contributes to ongoing systemic inequality in the prevailing drug war.

Stick and Tell A Survey of Emergency Medicine Residents and Needlestick Exposures

2013 ◽  
Vol 34 (10) ◽  
pp. 1116-1118 ◽  
Author(s):  
Jessica Zuraw ◽  
Gretchen Sanford ◽  
Lori Winston ◽  
Shu Chan
Keyword(s):  
Emergency Medicine ◽  
Healthcare Workers ◽  
The United States ◽  
Perceived Barriers ◽  
Health Departments ◽  
Needlestick Injuries ◽  
Residency Programs ◽  
Paper Version ◽  
E Mail ◽  
New Procedures

An estimated 400,000–800,000 sharps-related injuries occur among healthcare workers (HCWs) annually in the United States. The risk of needlestick exposure may be particularly high among emergency medicine (EM) residents, who are learning new procedures in a relatively uncontrolled environment. Despite the potentially serious consequences of percutaneous injuries (PCIs), practitioners in training often down-play the occurrence of PCIs and do not report exposures.Current literature implies that underreporting of needlestick injuries is multifactorial. By not seeking care after needlesticks occur and thereby delaying treatment, residents incur more risk from exposures. We sought to elucidate the underlying issues that might contribute to this lack of reporting needlestick injuries. Using an anonymous survey, we collected information regarding factors that contributed to sustaining a PCI as well as perceived barriers that prevented residents from reporting these exposures. This information is desirable for both residency programs and employee health departments to reduce the occurrence of unreported exposures.The survey contained 19 questions, and all subjects were EM residents from the 8 Accreditation Council for Graduate Medical Education–accredited programs in the state of Illinois during the period January–February 2011. The voluntary survey was distributed via e-mail and through a paper version distributed at a regional EM residency conference.

Framework Development for an Immediate Postpartum Long-Acting Reversible Contraception Program

2020 ◽  
Vol 13 (1) ◽  
pp. 25-30
Author(s):  
Jessica Poulsen ◽  
Kylea Liese
Keyword(s):  
Critical Time ◽  
The United States ◽  
Perceived Barriers ◽  
Successful Implementation ◽  
Time Period ◽  
Complex Process ◽  
Maternal Morbidity And Mortality ◽  
Long Acting ◽  
Framework Development ◽  
E Mail

BackgroundWith the high rates of unintended pregnancy and associated maternal morbidity and mortality in the United States, particularly among poor and minority women, it is imperative that all individuals have information about and access to long-acting reversible contraception (LARC) methods in the immediate postpartum period.ObjectiveThe creation of a framework to provide guidance, address barriers, and dispel myths associated with the implementation of an immediate postpartum LARC program.MethodsA multistep approach to develop a framework to guide planning and implementation of an immediate postpartum LARC program. A literature review, telephone and e-mail interviews with clinical experts involved with successful implementation of immediate postpartum LARC programs, development of a list of interdisciplinary specialists, and steps required to initiate a change in current practice.ResultsThe provision of a framework to guide the planning and implementation of an immediate postpartum LARC program to streamline the process while addressing perceived barriers and myths.ConclusionsAddressing the lack of knowledge about LARCs, financial concerns, and absence of a standardized framework related to planning and implementation of this complex process will hopefully begin the process of making effective and reliable contraception available.Implications for NursingThe use of a standardized framework to guide the implementation of an immediate postpartum LARC program provides the potential for easier access to LARC methods in this critical time period.

Epidemiology of Substance Use Disorders

2020 ◽  
pp. 3-28
Author(s):  
L. Morgan Snell ◽  
Andrew J. Barnes ◽  
Peter Cunningham
Keyword(s):  
The United States ◽  
Opioid Use Disorder ◽  
Opioid Overdose ◽  
Prescription Opioids ◽  
Opioid Epidemic ◽  
Provider Education ◽  
Opioid Use ◽  
Prescribing Practices ◽  
The Us ◽  
Overdose Deaths

Nearly 3 million Americans have a current or previous opioid use disorder, and recent data indicate that 10.2% of US adults have ever misused pain relievers. In 2015, approximately 800,000 individuals used heroin, while 4 million misused prescription opioids. Although use of other drugs such as alcohol and cannabis is more prevalent, opioid use contributes to significant morbidity, mortality, and social and economic costs. While the current US opioid overdose epidemic began with prescription opioids, since 2015, heroin and synthetic opioids (e.g., fentanyl) have driven continued increases in opioid overdose deaths, contributing to a recent decline in overall life expectancy in the United States. Policies to address the opioid epidemic by changing clinical practice include provider education, monitoring prescribing practices, and expanding the clinical workforce necessary to treat opioid use disorders. The opioid epidemic appears to be largely a US phenomenon and a consequence of both structural challenges in the US healthcare system and growing socioeconomic disparities, and thus it will require policies including and beyond delivery system reforms to resolve it.

Development of a Set of Indicators to Evaluate Injury Control Research Centers

2014 ◽  
Vol 38 (2) ◽  
pp. 133-159 ◽  
Author(s):  
Carol Runyan ◽  
Mariana Garrettson ◽  
Sue Lin Yee
Keyword(s):  
Academic Research ◽  
Mail Survey ◽  
Research Centers ◽  
Telephone Interviews ◽  
Control Research ◽  
Control And Prevention ◽  
The Individual ◽  
Injury Research ◽  
Injury Control ◽  
E Mail

Background: Few methods have been defined for evaluating the individual and collective impacts of academic research centers. In this project, with input from injury center directors, we systematically defined indicators to assess the progress and contributions of individual Injury Control Research Centers (ICRCs) and, ultimately, to monitor progress of the overall injury center program. Method: We used several methods of deriving a list of recommended priority and supplemental indicators. This included published literature review, telephone interviews with selected federal agency staff, an e-mail survey of injury center directors, an e-mail survey of staff at the Centers for Disease Control and Prevention, a two-stage Delphi process (e-mailed), and an in-person focus group with injury center directors. We derived the final indicators from an analysis of ratings of potential indicators by center directors and CDC staff. We also examined qualitative responses to open-ended items that address conceptual and implementation issues. Results: All currently funded ICRCs participated in at least one part of the process, resulting in a list of 27 primary indicators (some with subcomponents), 31 supplemental indicators, and multiple suggestions for using the indicators. Conclusion: Our results support an approach that combines standardized definitions and quantifiable indicators with qualitative reporting, which allows consideration of center distinctions and priorities. The center directors urged caution in using the indicators, given funding constraints and recognition of unique institutional environments. While focused on injury research centers, we suggest these indicators also may be useful to academic research centers of other types.

scholarly journals Emerging and Continuing Trends in Opioid Overdose Decedent Characteristics during COVID-19

2021 ◽  
Author(s):  
Gian-Gabriel P. Garcia ◽  
Erin Stringfellow ◽  
Catherine DiGennaro ◽  
Nicole Poellinger ◽  
Jaden Wood ◽  
...  
Keyword(s):  
North Carolina ◽  
Rhode Island ◽  
Race And Ethnicity ◽  
The United States ◽  
Vital Statistics ◽  
Opioid Overdose ◽  
Cross Sectional ◽  
Death Rates ◽  
Overdose Death ◽  
Overdose Deaths

Background: Since COVID-19 erupted in the United States, little is known about how state-level opioid overdose trends and decedent characteristics have varied throughout the country. Objective: Investigate changes in annual overdose death rates, substances involved, and decedent demographics in opioid overdose deaths across nine states; assess whether 2019-2020 trends were emerging (i.e., change from 2019-2020 was non-existent from 2018-2019) or continuing (i.e., change from 2019-2020 existed from 2018-2019). Design: Cross-sectional study using vital statistics data to conduct a retrospective analysis comparing 2020 to 2019 and 2019 to 2018 across nine states. Setting: Alaska, Colorado, Connecticut, Indiana, Massachusetts, North Carolina, Rhode Island, Utah, and Wyoming. Participants: Opioid-related overdose deaths in 2018, 2019, and 2020. Measurements: Annual overdose death rate, proportion of overdose deaths involving specific substances, and decedent demographics (age, sex, race, and ethnicity). Results: We find emerging increases in annual opioid-related overdose death rates in Alaska (55.3% [P=0.020]), Colorado (80.2% [P<0.001]), Indiana (40.1% [P=0.038]), North Carolina (30.5% [P<0.001]), and Rhode Island (29.6% [P=0.011]). Decreased heroin-involved overdose deaths were emerging in Alaska (-49.5% [P=0.001]) and Indiana (-58.8% [P<0.001]), and continuing in Colorado (-33.3% [P<0.001]), Connecticut (-48.2% [P<0.001]), Massachusetts (39.9% [P<0.001]), and North Carolina (-34.8% [P<0.001]). Increases in synthetic opioid presence were emerging in Alaska (136.5% [P=0.019]) and Indiana (27.6% [P<0.001]), and continuing in Colorado (44.4% [P<0.001]), Connecticut (3.6% [P<0.05]), and North Carolina (14.6% [P<0.001]). We find emerging increases in the proportion of male decedents in Colorado (15.2% [P=0.008]) and Indiana (12.0% [P=0.013]). Limitations: Delays from state-specific death certification processes resulted in varying analysis periods across states. Conclusion: These findings highlight emerging changes in opioid overdose dynamics across different states, which can inform state-specific public health interventions.

scholarly journals Pandemic meets epidemic: Co-location of COVID-19 and drug overdose deaths in the United States

2021 ◽  
Vol 6 (4) ◽  
pp. 174-178
Author(s):  
Navya Tripathi ◽  
Nancy Hardt
Keyword(s):  
United States ◽  
Spatial Correlation ◽  
Drug Overdose ◽  
Hot Spot ◽  
State Level ◽  
The United States ◽  
Time Step ◽  
Access To Treatment ◽  
Control And Prevention ◽  
Overdose Deaths

Drug overdose deaths (DOD) in the last two decades have increased over 300 percent. In 2019 alone, 71,000 deaths represented a 7% increase from the previous year. According to recent data released by the Center for Disease Control and Prevention (CDC), 81,230 overdose deaths occurred in the United States from June 2019 to May 2020, the highest number of DOD recorded in a 12-month period. Early 2020 saw the spread of the COVID-19 pandemic in the United States, which CDC suggests has amplified the previously alarming rise in drug-related mortalities. A hot spot analysis of COVID-19 and DOD rates, as well as a spatial correlation between the two datasets at the state level on a monthly time step, showed a significant increase in DOD during the COVID-19 pandemic. This study, conducted for the period of March through July 2021, showed a spatial correlation between the two types of mortalities in the initial months of 2020. Furthermore, the hot spots for both types of mortalities were concentrated in the northeastern states. The COVID-19 mortalities shifted southeast in July 2020, but DOD data was unavailable for further analysis. Since DOD are a leading contributor to preventable deaths, the results of the study may help focus the efforts of effective and innovative programs to reduce substance use disorder and related mortality through increased access to treatment. During the pandemic, access to such facilities was reduced.

scholarly journals The Rapid Escalation of Fentanyl in Illicit Drug Evidence in Allegheny County, Pennsylvania, 2010-2016

2018 ◽  
Vol 133 (2) ◽  
pp. 142-146 ◽  
Author(s):  
Kathleen E. Creppage ◽  
Joshua Yohannan ◽  
Karl Williams ◽  
Jeanine M. Buchanich ◽  
Thomas J. Songer ◽  
...  
Keyword(s):  
Law Enforcement Officers ◽  
The United States ◽  
New Drugs ◽  
Opioid Overdose ◽  
Surveillance Systems ◽  
Allegheny County ◽  
Health Authorities ◽  
Drug Overdoses ◽  
Public Health Authorities ◽  
Overdose Deaths

Opioid overdose deaths in the United States quadrupled from 1999 (n = 8050 deaths) to 2015 (n = 33 091 deaths), and the number of deaths associated with synthetic opioids, such as fentanyl, increased from 3105 deaths in 2013 to nearly 20 000 deaths in 2016. Given this rapid increase, timely surveillance for drugs in circulation is crucial. However, current surveillance systems used to track drug overdoses do not detect new drugs in circulation quickly. We studied the change in the presence of fentanyl in “stamp bag” drug evidence in Allegheny County, Pennsylvania, from 2010 through 2016. Stamp bags are small wax packets with individual stamps that contain mixtures of drugs, most commonly heroin, that law enforcement officers seize and retain as legal evidence. The proportion of stamp bags determined to contain fentanyl or a fentanyl analog was 2.1% in 2014 and rose sharply to 17.1% in 2016. Monitoring the chemical makeup of drug evidence items could help public health authorities identify drug use trends in their jurisdictions.

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