NIOSH Responds to the U.S. Drug Overdose Epidemic

2021 ◽  
pp. 104829112110407
Author(s):  
Jamie C. Osborne ◽  
L. Casey Chosewood
Keyword(s):  
United States ◽  
Substance Use ◽  
Drug Overdose ◽  
Drug Users ◽  
Illicit Drugs ◽  
Occupational Safety ◽  
The United States ◽  
Opioid Use Disorder ◽  
Opioid Overdose ◽  
Opioid Use

The United States is experiencing an evolving and worsening drug overdose epidemic. Although the rate of drug use among workers has remained relatively stable, the risk of overdose and death among drug users has not, as illicit drugs have increased in potency and lethality. The cumulative impacts of COVID-19 and the opioid crisis increase the likelihood of illness and death among workers with opioid use disorder. Workplaces represent a critical point of contact for people living in the United States who are struggling with or recovering from a substance use disorder, and employment is a vital source of recovery “capital.” The benefits of addressing substance use in the workplace, supporting treatment, and employing workers in recovery are evident. The National Institute for Occupational Safety and Health has published research to inform policy and practice toward prevention efforts and has developed accessible resources and toolkits to support workers, employers, and workplaces in combatting the opioid overdose crisis and creating safer, healthier communities.

scholarly journals Relapse rates among veterans on maintenance doses of combination buprenorphine and naloxone for opioid use disorder

2020 ◽  
Vol 10 (3) ◽  
pp. 80-84
Author(s):  
Katie J. Binger ◽  
Elayne D. Ansara ◽  
Talia M. Miles ◽  
Samantha L. Schulte
Keyword(s):  
Substance Use ◽  
The United States ◽  
Opioid Use Disorder ◽  
Opioid Overdose ◽  
Opioid Use ◽  
Significant Difference ◽  
Secondary Outcomes ◽  
The Difference ◽  
Time To Relapse ◽  
Recovery Program

Abstract Introduction Opioid use disorder (OUD) can cause significant morbidity and mortality with more than 115 people dying from an opioid overdose daily in the United States. Treatment with buprenorphine/naloxone (BUP/NAL) can be effective; however, there is conflicting evidence on the utility of higher doses in preventing relapse. This study was designed to assess BUP/NAL maintenance doses and the rate of relapse in veterans with OUD. Methods Patients diagnosed with OUD who received a prescription for BUP/NAL through the substance use disorder recovery program were retrospectively evaluated. Patients were categorized into 2 treatment groups: those prescribed ≤16 mg of BUP/NAL daily and those prescribed >16 mg of BUP/NAL daily. The primary outcome was to determine rates of relapse between maintenance doses of BUP/NAL. Secondary outcomes included evaluating the difference in rates of relapse between daily versus take-home dosing, tablets versus films, time to relapse, and use of illicit substances during treatment. Results Patients prescribed >16 mg of BUP/NAL daily had statistically significantly lower rates of relapse compared to patients prescribed ≤16 mg of BUP/NAL daily (P = .0018). Regarding secondary outcomes, there was a statistically significant difference in time to relapse (P = .036) and dosage form (P = .0124). Difference in administration of dose and illicit substance use during treatment were not statistically significant. Discussion This study identified that rate of relapse can be lowered and time to relapse can be lengthened when doses >16 mg of BUP/NAL are prescribed in the veteran population for OUD.

scholarly journals Rules for Establishing Causation in Opiate/Opioid Overdose Prosecutions — The Burrage Decision

2017 ◽  
Vol 7 (1) ◽  
pp. 87-90
Author(s):  
Thomas P. Gilson ◽  
Carole Rendon ◽  
Joseph Pinjuh
Keyword(s):  
United States ◽  
Law Enforcement ◽  
Drug Overdose ◽  
Expert Testimony ◽  
Illicit Drugs ◽  
Burden Of Proof ◽  
The United States ◽  
Opioid Overdose ◽  
Legal Proceedings ◽  
Insight Into

As the opiate/opioid crisis has worsened in the United States, one of the law enforcement responses has involved increased efforts to prosecute the individuals responsible for the distribution of illicit drugs that result in overdoses. When mixed intoxications occur, the controlling decision for prosecution is Burrage v. United States (2014), which provides guidance on the types of evidence required for establishment of causation. In many types of legal proceedings, forensic pathologists are called to provide expert testimony, although they may be unaware of the burden of proof that is required in a given case. This paper seeks to elaborate upon the burden of proof in drug overdose prosecutions with the guidance of Burrage and offer insight into the expectations and limitations involved in these cases.

scholarly journals 1421. Assessing Serious Infections Common in Persons Who Inject Drugs in the United States and Tennessee

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S717-S718
Author(s):  
Michael Lowry ◽  
Christina Fiske ◽  
Peter F Rebeiro
Keyword(s):  
United States ◽  
Substance Use ◽  
Bacterial Infections ◽  
The United States ◽  
Opioid Use Disorder ◽  
Opioid Use ◽  
Persons Who Inject Drugs ◽  
Discharge Data ◽  
Serious Infections ◽  
The Us

Abstract Background The opioid crisis is a public health emergency in the United States (US) and Tennessee (TN), and injection drug use predisposes users to a variety of serious infections. We therefore examined infection rates among persons who inject drugs (PWID) from 2001-2014 in the US and TN. Methods We conducted an ecological study using publicly available data including discharge diagnosis codes: the Healthcare Cost and Utilization Project (HCUP). We identified all persons from 2001-2014 with ICD-9 codes for bacterial infections common among PWID: endocarditis (IE), osteomyelitis (OM), septic arthritis (SpA), and skin/soft tissue infections (SSTI). We calculated rates of substance use and infection among all hospital discharges. Spearman’s rank correlation quantified the relationship between infection and reported hepatitis C seropositivity (HCV), Substance Abuse (SA) and opioid use disorder (OUD) rates. Poisson regression yielded incidence rate ratios (IRR) and 95% confidence intervals [-], and restricted cubic splines were fit to assess annual trends flexibly. Results Unadjusted rates of both substance use and infection among those discharged from hospitals were higher in the US overall than in TN from 2001-2014 (p< 0.05) (Figure 2,3). Overall infections, HCV (IRR=1.14 [1.12-1.17]), SSTI, OM, and SpA increased annually in the US; overall infections, HCV (IRR=1.14 [1.10-1.15]), and SSTI increased in TN. OUD (IRR=0.96 [0.94-0.98]) and IE (IRR=0.97 [0.97-0.98]) decreased in the US (Table 1). In the US, there were strong positive correlations between any other infection and HCV (ρ=0.87), IE and OUD (ρ=0.7), SSTI and HCV (ρ=0.9), OM and HCV (ρ=0.69), and SpA and HCV (ρ=0.68); IE was negatively correlated with HCV (ρ=-0.84). In TN, overall infections (ρ=0.68), and specifically SSTI (ρ=0.62), were correlated with HCV (Figure 1). Table 1 Figure 1 Figure 2 Conclusion Serious infections common in PWID are increasing in TN and the US; they correlate with HCV rates, which have risen significantly in hospitalized patients. Interestingly, opioid use disorder incidence from discharge data declined from 2001-2014 for both TN and the US, which may be due to coding lapses or shifts in type of opioid use with no well-known billing code. However, we must continue monitoring and mitigating both substance use and its sequelae. Disclosures All Authors: No reported disclosures

Special Populations

2020 ◽  
pp. 379-408
Author(s):  
Michael I. Fingerhood
Keyword(s):  
Substance Use ◽  
Partner Violence ◽  
Illicit Drugs ◽  
Opioid Use Disorder ◽  
Treatment Programs ◽  
Opioid Overdose ◽  
Opioid Use ◽  
Need For Treatment ◽  
Increased Risk ◽  
Insight Into

There are a number of issues regarding substance use disorders (SUD) that are particular to certain populations. Adolescents tend to lack insight into problems that result from substance use. CRAFFT is a simple and reliable screening tool for SUD in adolescents. Treatment generally consists of counseling. Intimate partner violence is more common among women with SUD and those whose partners have SUD. During pregnancy, alcohol is the drug most damaging to the fetus. Treatment programs developed specifically for women may be beneficial. Most SUD in older adults are related to alcohol, but opioid use is increasing, with associated risk of overdose fatality. Lesbian, gay, bisexual, transgender, and queer (LGBTQ) individuals appear to be at increased risk for SUD. LGBTQ youth in particular have high rates of physical and sexual abuse, leading to high rates of opioid use disorder. Few programs specifically deliver LGBTQ-sensitive substance use treatment. At the time of incarceration, many arrestees test positive for illicit drugs or alcohol and perceive a need for treatment, but few receive it. Without medication for opioid use disorder while incarcerated, the risk of fatal opioid overdose soon after release is high. With regard to health professionals, the prevalence of alcohol use disorder is similar to that for the general population, although illicit drug use is less common. Medical societies have implemented programs to address SUD in the health professions.

scholarly journals “The elephant in the room;” a qualitative study of perinatal fears in opioid use disorder treatment in Southern Appalachia

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Catherine Leiner ◽  
Tamara Cody ◽  
Nathan Mullins ◽  
Melinda Ramage ◽  
Bayla M. M. Ostrach
Keyword(s):  
United States ◽  
Substance Use ◽  
Focus Group ◽  
Social Services ◽  
The United States ◽  
Opioid Use Disorder ◽  
Substance Use Treatment ◽  
Opioid Use ◽  
Treatment Access ◽  
Subset Analysis

Abstract Background Diagnoses of perinatal opioid use disorder (OUD) continue to rise in the United States. Patients and providers report obstacles to OUD treatment access. Difficulties include legal ambiguity related to Social Services notification requirements following a birth to people using opioids or in medication-assisted treatment for OUD. Methods Through semi-structured interviews, participant-observation, and a focus group conducted in a mostly rural, region of the Southern United States (where perinatal OUD is more prevalent), patients’ and providers’ perspectives about perinatal substance use treatment were initially sought for a larger study. The findings presented here are from a subset analysis of patients’ experiences and perspectives. Following ethics review and exemption determination, a total of 27 patient participants were opportunistically, convenience, and/or purposively sampled and recruited to participate in interviews and/or a focus group. Data were analyzed using modified Grounded Theory. Results When asked about overall experiences with and barriers to accessing perinatal substance use treatment, 11 of 27 participants reported concerns about Social Services involvement resulting from disclosure of their substance use during pregnancy. In the subset analysis, prevalent themes were Fears of Social Services Involvement, Preparation for Delivery, and Providers Addressing Fears. Conclusions Perinatal OUD patients may seek substance use treatment with existing fears of Social Services involvement. Patients appreciate providers’ efforts to prepare them for this potential reality. Providers should become aware of how their own hospital systems, counties, states, and countries interpret laws governing notification requirements. By becoming aware of patients’ fears, providers can be ready to discuss the implications of Social Services involvement, promote patient-centered decision-making, and increase trust.

scholarly journals Assessing the Relationships Between COVID-19 Stay-at-Home Orders and Opioid Overdoses in the State of Pennsylvania

2021 ◽  
pp. 002204262110063
Author(s):  
Brian King ◽  
Ruchi Patel ◽  
Andrea Rishworth
Keyword(s):  
Age Groups ◽  
The United States ◽  
Opioid Use Disorder ◽  
Opioid Overdose ◽  
Policy Recommendations ◽  
Opioid Use ◽  
Fentanyl Analogs ◽  
Measure Change ◽  
Using Data ◽  
At Home

COVID-19 is compounding opioid use disorder throughout the United States. While recent commentaries provide useful policy recommendations, few studies examine the intersection of COVID-19 policy responses and patterns of opioid overdose. We examine opioid overdoses prior to and following the Pennsylvania stay-at-home order implemented on April 1, 2020. Using data from the Pennsylvania Overdose Information Network, we measure change in monthly incidents of opioid-related overdose pre- versus post-April 1, and the significance of change by gender, age, race, drug class, and naloxone doses administered. Findings demonstrate statistically significant increases in overdose incidents among both men and women, White and Black groups, and several age groups, most notably the 30–39 and 40–49 ranges, following April 1. Significant increases were observed for overdoses involving heroin, fentanyl, fentanyl analogs or other synthetic opioids, pharmaceutical opioids, and carfentanil. The study emphasizes the need for opioid use to be addressed alongside efforts to mitigate and manage COVID-19 infection.

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