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

Author(s):  
Scott Fulmer ◽  
Shruti Jain ◽  
David Kriebel

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.

2020 ◽  
Vol 6 ◽  
pp. 205032452094042 ◽  
Author(s):  
Jasmine Drake ◽  
Creaque Charles ◽  
Jennifer W Bourgeois ◽  
Elycia S Daniel ◽  
Melissa Kwende

Context: In recent years, due to an alarming increase in the number of opioid-related overdose fatalities for White, Non-Hispanics in rural and suburban communities across the United States, they have been considered as the face of this epidemic. However, there has also been a staggering rise in the number of opioid overdoses in urban, minority communities, which have not been thoroughly addressed by the literature. Methods We reviewed deaths where opioid-related substances were reported as the leading cause of death to the Centers of Disease Control Multiple Cause of Death database from 1999 to 2017. Deaths were analyzed by year, State, drug type, and race and ethnicity. Results There were 399,230 total opioid-related deaths from 1999 to 2017 amongst all ethnic groups in the U.S. During this timeframe, approximately 323,939 total deaths were attributed to White, Non-Hispanics, while 75,291 were attributed to all other ethnicities. Examination of opioid-related overdose death data by ethnicity reveals that while White, Non-Hispanics have experienced the largest numbers of opioid-related overdose deaths in the U.S with up to 37,113 deaths occurring during 2017, there has also been a sharp rise in the number of opioid-related overdose deaths for minorities. opioid-related overdose deaths for Black, Non-Hispanics climbed from 1130 deaths in 1999 to 5513 deaths in 2017, while opioid-related overdose deaths for Hispanics climbed from 1058 in 1999 to 3932 in 2017. According to the Centers for Disease Control and Prevention, over the past 19 years, age-adjusted opioid-related deaths for Hispanics have climbed from 3.5 overdoses per 100,000 in 1999 to 6.8 overdoses per 100,000 in 2017. However, greater increases have been reported for Blacks during the same 19-year timeframe with age-adjusted rates of 3.5 overdoses per population of 100,000 in 1999 to 12.9 overdoses per population of 100,000 in 2017. Conclusion While Opioid-related overdoses have overwhelmingly plagued rural and suburban White, Non-Hispanic communities, there has been a surge in the number of deaths in Black and Hispanic Minority communities in recent years. Although there have been significant increases in the number of opioid-related overdose deaths in Black and Hispanic communities, the media narrative for this epidemic is often portrayed as a White, Non-Hispanic rural and suburban crisis. As a result, intervention strategies and policies have failed, both, to assess the severity of the problem in minority communities and to offer culturally sensitive preventative and treatment solutions. In this paper, the impact of the opioid epidemic on Black and Hispanic minority communities will be presented. Racial disparities in the U.S. Government’s current approach to an epidemic, which plagues rural and suburban White America, will be compared to its past criminal justice response to drug pandemics in urban minority communities. Culturally sensitive policy considerations and recommendations that can be used to, both, mitigate and offer treatment options for the opioid epidemic in these minority communities will also be addressed.


2018 ◽  
Vol 1 (21;1) ◽  
pp. 309-326 ◽  
Author(s):  
Laxmaiah Manchikanti

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)


Demography ◽  
2021 ◽  
Vol 58 (1) ◽  
pp. 345-378
Author(s):  
Mónica L. Caudillo ◽  
Andrés Villarreal

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.


2021 ◽  
Vol 10 (19) ◽  
pp. 4498
Author(s):  
Alberto Barcelo ◽  
Alfredo Valdivia ◽  
Angelo Sabag ◽  
Juan Pablo Rey-Lopez ◽  
Arise Garcia de Siqueira Galil ◽  
...  

Background: Diabetes accounted for approximately 10% of all-cause mortality among those 20–79 years of age worldwide in 2019. In 1986–1989, Hispanics in the United States of America (USA) represented 6.9% of the national population with diabetes, and this proportion increased to 15.1% in 2010–2014. Recently published findings demonstrated the impact of attained education on amenable mortality attributable to diabetes among Non-Hispanic Whites (NHWs) and Non-Hispanic Blacks (HNBs). Previous cohort studies have shown that low education is also a detrimental factor for diabetes mortality among the Hispanic population in the USA. However, the long-term impact of low education on diabetes mortality among Hispanics in the USA is yet to be determined. Aims and methods: The aim of this study was to measure the impact of achieving a 12th-grade education on amenable mortality due to diabetes among Hispanics in the USA from 1989 to 2018. We used a time-series designed to analyze death certificate data of Hispanic-classified men and women, aged 25 to 74 years, whose underlying cause of death was diabetes, between 1989 and 2018. Death certificate data from the USA National Center for Health Statistics was downloaded, as well as USA population estimates by age, sex, and ethnicity from the USA Census Bureau. The analyses were undertaken using JointPoint software and the Age–Period–Cohort Web Tool, both developed by the USA National Cancer Institute. Results: The analyses showed that between 1989 to 2018, age- and sex-standardized diabetes mortality rates among the least educated individuals were higher than those among the most educated individuals (both sexes together, p = 0.036; males, p = 0.053; females, p = 0.036). The difference between the least and most educated individuals became more pronounced in recent years, as shown by independent confidence intervals across the study period. Sex-based analyses revealed that the age-adjUSAted diabetes mortality rate had increased to a greater extent among the least educated males and females, respectively, than among the most educated. Conclusions: The results of the analyses demonstrated a powerful effect of low education on amenable mortality attributable to diabetes among the Hispanic population in the USA. As an increasing prevalence of diabetes among the least educated Hispanics has been reported, there is a great need to identify and implement effective preventive services, self-management, and quality care practices, that may assist in reducing the growing disparity among those most vulnerable, such as minority populations.


2021 ◽  
Author(s):  
Daniel E. Kaufman ◽  
Asawer M. Nihal ◽  
Janan D. Leppo ◽  
Kelly M. Staples ◽  
Kenneth L. McCall ◽  
...  

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.


2008 ◽  
Vol 17 (6) ◽  
pp. 474-479 ◽  
Author(s):  
Jonathan R. Bennion ◽  
Matthew E. Wise ◽  
John A. Carver ◽  
Frank Sorvillo

2019 ◽  
Vol 18 (1) ◽  
pp. 40-43
Author(s):  
Francisco Brenes ◽  
Federico Henriquez

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.


2021 ◽  
pp. 002242782098684
Author(s):  
Richard Rosenfeld ◽  
Joel Wallman ◽  
Randolph Roth

Objectives: Evaluate the relationship between the opioid epidemic and homicide rates in the United States. Methods: A county-level cross-sectional analysis covering the period 1999 to 2015. The race-specific homicide rate and the race-specific opioid-related overdose death rate are regressed on demographic, social, and economic covariates. Results: The race-specific opioid-related overdose death rate is positively associated with race-specific homicide rates, net of controls. The results are generally robust across alternative samples and model specifications. Conclusions: We interpret the results as reflecting the violent dynamics of street drug markets, although more research is needed to draw definitive conclusions about the mechanisms linking opioid demand and homicide.


Stroke ◽  
2011 ◽  
Vol 42 (8) ◽  
pp. 2351-2355 ◽  
Author(s):  
Amytis Towfighi ◽  
Jeffrey L. Saver

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