scholarly journals Evidence of Modeling Impact in Development of Policies for Controlling the Opioid Epidemic and Improving Public Health: A Scoping Review

2019 ◽  
Vol 13 ◽  
pp. 117822181986621 ◽  
Author(s):  
Nasser Sharareh ◽  
Shabnam S Sabounchi ◽  
Mary McFarland ◽  
Rachel Hess
Keyword(s):  
Public Health ◽  
Scoping Review ◽  
Conceptual Modeling ◽  
The United States ◽  
Opioid Addiction ◽  
Dynamics Simulation ◽  
Prescription Opioid ◽  
Opioid Overdose ◽  
Opioid Epidemic ◽  
The Impact

Background: Opioid addiction and overdose rates are reaching unprecedented levels in the U.S., with around 47,736 overdose deaths in 2017. Many stakeholders affect the opioid epidemic, including government entities, healthcare providers and policymakers, and opioid users. Simulation and conceptual modeling can help us understand the dynamics of the opioid epidemic by simplifying the real world and informing policymakers about different health interventions that could reduce the deaths caused by opioid overdose in the United States every year. Objectives: To conduct a scoping review of simulation and conceptual models that propose policies capable of controlling the opioid epidemic. We demonstrate the strengths and limitations of these models and provide a framework for further improvement of future decision support tools. Methods: Using the methodology of a scoping review, we identified articles published after 2000 from eight electronic databases to map the literature that uses simulation and conceptual modeling in developing public health policies to address the opioid epidemic. Results: We reviewed 472 papers of which 14 were appropriate for inclusion. Each used either system dynamics simulation modeling, mathematical modeling, conceptual modeling, or agent-based modeling. All included studies tested and proposed strategies to improve health outcomes related to the opioid epidemic. Factors considered in the models included physicians prescribing opioids, trafficking, users recruiting new users, and doctor shopping; no model investigated the impact of age and spatial factors on the dynamics of the epidemic. Key findings from these studies were (1) prevention of opioid initiation is better than treatment of opioid addiction, (2) the analysis of an intervention’s impact should include both benefits and harms, and (3) interventions with short-term benefits might have a counterproductive impact on the epidemic in long run. Conclusions: While most studies examined the role of prescription opioids and trafficking on this epidemic, the transition of patients from prescription opioid use to nonprescription use including heroin and synthetic opioids such as fentanyl impacts the system significantly and results in an epidemic with quite different characteristics than what it had a decade ago. We recommend including the impact of age and geographic location on the opioid epidemic using modeling methods.

scholarly journals A Critical Review of the Social and Behavioral Contributions to the Overdose Epidemic

2020 ◽  
Vol 42 (1) ◽  
Author(s):  
Magdalena Cerdá ◽  
Noa Krawczyk ◽  
Leah Hamilton ◽  
Kara E. Rudolph ◽  
Samuel R. Friedman ◽  
...  
Keyword(s):  
Public Health ◽  
Public Health Problem ◽  
The United States ◽  
Social Contexts ◽  
Prescription Opioid ◽  
Annual Review ◽  
Publication Date ◽  
Opioid Overdose ◽  
The Social ◽  
Critical Public Health

More than 750,000 people in the United States died from an overdose between 1999 and 2018; two-thirds of those deaths involved an opioid. In this review, we present trends in opioid overdose rates during this period and discuss how the proliferation of opioid prescribing to treat chronic pain, changes in the heroin and illegally manufactured opioid synthetics markets, and social factors, including deindustrialization and concentrated poverty, contributed to the rise of the overdose epidemic. We also examine how current policies implemented to address the overdose epidemic may have contributed to reducing prescription opioid overdoses but increased overdoses involving illegal opioids. Finally, we identify new directions for research to understand the causes and solutions to this critical public health problem, including research on heterogeneous policy effects across social groups, effective approaches to reduce overdoses of illegal opioids, and the role of social contexts in shaping policy implementation and impact. Expected final online publication date for the Annual Review of Public Health, Volume 42 is April 1, 2021. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.

scholarly journals If We Build It, Will They Come? Perspectives on Pharmacy-Based Naloxone Among Family and Friends of People who use Opioids: A Mixed Methods Study

2021 ◽  
Author(s):  
Susannah Slocum ◽  
Jenny E. Ozga ◽  
Alexander Y. Walley ◽  
Robin A. Pollini ◽  
Rebecca Joyce
Keyword(s):  
Mixed Methods ◽  
Drug Use ◽  
Support Groups ◽  
Perceived Risk ◽  
The United States ◽  
Opioid Antagonist ◽  
Prescription Opioid ◽  
Opioid Overdose ◽  
Opioid Use ◽  
The Impact

Abstract Background: Expanding access to the opioid antagonist naloxone to reduce overdose mortality is a public health priority in the United States. Naloxone standing orders (NSOs) have been established in many states to increase naloxone dispensing at pharmacies, but increased pharmacy access does not ensure optimal uptake among those likely to witness an overdose. In a prior statewide purchase trial, we documented high levels of naloxone access at Massachusetts pharmacies under a statewide NSO. In this study, we characterize barriers to pharmacy-based naloxone uptake among potential opioid overdose “bystanders” (friends or family of people who use opioids) that may be amenable to intervention.Methods: Eligible bystanders were Massachusetts residents >18 years of age, did not use illicit opioids in the past 30 days, and knew someone who currently uses illicit opioids. We used a sequential mixed methods approach, in which a series of semi-structured qualitative interviews (N=22) were conducted to inform the development of a subsequent quantitative survey (N=260). Results: Most survey participants (77%) reported ever obtaining naloxone but few (21%) attempted to purchase it at a pharmacy. Qualitative participants revealed that barriers to utilizing the NSO included low perceived risk of overdose, which was rooted in misconceptions regarding the risks of prescription opioid misuse, denial about their loved one’s drug use, and drug use stereotypes; inaccurate beliefs about the impact of naloxone on riskier opioid use; and concerns regarding anticipated stigma and confidentiality. Many participants had engaged in mutual support groups, which served as a source of free naloxone for half (50%) of those who had ever obtained naloxone.Conclusions: Despite high levels of pharmacy naloxone access in Massachusetts, few bystanders in our study had attempted to obtain naloxone under the NSO. Low perceived risk of overdose, misinformation, stigma and confidentiality were important barriers to pharmacy naloxone uptake, all of which are amenable to intervention. Support groups provided a setting for addressing stigma and misinformation and provided a discreet and comfortable setting for naloxone access. Where these groups do not exist and for bystanders who do not participate in such groups, pharmacies are well-positioned to fill gaps in naloxone availability.

Assessing the Impact of Person-level Matching Algorithms to Identify Risk of Fatal Opioid Overdose Across Disparate Datasets: Retrospective Analysis (Preprint)

2020 ◽  
Author(s):  
Lindsey Ferris ◽  
Jonathan P. Weiner ◽  
Brendan Saloner ◽  
Hadi Kharrazi
Keyword(s):  
Public Health ◽  
Risk Factors ◽  
At Risk ◽  
Area Under The Curve ◽  
The United States ◽  
Risk Indicators ◽  
Mortality Data ◽  
Opioid Overdose ◽  
Fatal Overdose ◽  
The Impact

BACKGROUND The opioid epidemic in the United States has precipitated a need for public health agencies to better understand risk factors associated with fatal overdoses. Matching person-level information stored in public health, medical, and human services datasets can enhance the understanding of opioid overdose risk factors and interventions. A major impediment to using datasets from separate agencies, has been the lack of a cross-organization unique identifier. Although different matching techniques that leverage patient demographic information can be used, the impact of using a particular matching approach is not well understood. OBJECTIVE This study compares the impact of using probabilistic versus deterministic matching algorithms to link disparate datasets together for identifying persons at risk of a fatal overdose. METHODS This study used statewide prescription drug monitoring program (PDMP), arrest, and mortality data matched at the person-level using a probabilistic and two deterministic matching algorithms. Impact of matching was assessed by comparing the prevalence of key risk indicators, the outcome, and performance of a multivariate logistic regression for fatal overdose using the combined datasets. RESULTS The probabilistically matched population had the highest degree of matching within the PDMP data and with arrest and mortality data, resulting in the highest prevalence of high-risk indicators and the outcome. Model performance using area under the curve (AUC) was comparable across the algorithms (probabilistic: 0.847; deterministic-basic: 0.854; deterministic+zip: 0.826), but demonstrated tradeoffs between sensitivity and specificity. CONCLUSIONS The probabilistic algorithm was more successful in linking patients with PDMP data with death and arrest data, resulting in a larger at-risk population. However, deterministic-basic matching may be a suitable option for understanding high-level risk based on the model’s area under the curve (0.854). The clinical use case should be considered when selecting a matching approach, as probabilistic algorithms can be more resource-intensive and costly to maintain compared with deterministic algorithms.

scholarly journals A 10-Year Review of Opioid-Related Deaths at West Tennessee Regional Forensic Center: 2007-2017

2021 ◽  
Author(s):  
Haley St. John ◽  
Juliette Scantlebury
Keyword(s):  
Age Groups ◽  
The United States ◽  
Prescription Opioid ◽  
Opioid Overdose ◽  
Prescription Opioids ◽  
Opioid Epidemic ◽  
Opioid Prescription ◽  
Primary Driver ◽  
West Tennessee ◽  
Forensic Center

Prescription opioid deaths have tripled since 1999, and currently opioid overdose kills 115 Americans per day on average (1). Prior to 2014, prescription opioids have been the primary driver of opioid-related mortality. In recent years, the United States has seen a steady decline in the rate of opioid prescription. At the same time, there has been a significant increase in the number of deaths attributed to non-prescription opioids such as heroin, illicitly manufactured fentanyl, and fentanyl analogues. In 2017, among 70,237 drug overdose deaths nationally, 47,600 (67.8%) involved opioids, with increases across age groups, racial/ethnic groups, and county urbanization levels in multiple states (2). The opioid epidemic is especially profound in Tennessee, which had the 3rd highest opioid prescription rate in the country in 2017 and an opioid-related death rate of 19.3 deaths per 100,000 persons, compared to the national average of 14.6 (3). This retrospective study analyzes autopsy data from West Tennessee Regional Forensic Center (WTRFC) from 2007 to 2017 to gain a better understanding of the effects of the opioid epidemic on West Tennessee and the surrounding areas. Data from opioid-related accidents and suicides were analyzed in order to identify trends in race, age, gender, location, types of opioids, and drug combinations involved in opioid-related deaths.

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

2021 ◽  
pp. 104829112110234
Author(s):  
Scott Fulmer ◽  
Shruti Jain ◽  
David Kriebel
Keyword(s):  
United States ◽  
Cause Of Death ◽  
Death Certificate ◽  
The United States ◽  
Opioid Overdose ◽  
Commercial Fishing ◽  
Opioid Epidemic ◽  
Death Certificate Data ◽  
Deaths Of Despair

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.

scholarly journals Dual MD–MPH Degree Students in the United States: Moving the Medical Workforce Toward Population Health

2021 ◽  
pp. 003335492097842
Author(s):  
Jo Marie Reilly ◽  
Christine M. Plepys ◽  
Michael R. Cousineau
Keyword(s):  
Public Health ◽  
United States ◽  
Population Health ◽  
Health Care Policy ◽  
The United States ◽  
Extensive Literature ◽  
Master Of Public Health ◽  
Telephone Interviews ◽  
Public Health Training ◽  
The Impact

Objective A growing need exists to train physicians in population health to meet the increasing need and demand for physicians with leadership, health data management/metrics, and epidemiology skills to better serve the health of the community. This study examines current trends in students pursuing a dual doctor of medicine (MD)–master of public health (MPH) degree (MD–MPH) in the United States. Methods We conducted an extensive literature review of existing MD–MPH databases to determine characteristics (eg, sex, race/ethnicity, MPH area of study) of this student cohort in 2019. We examined a trend in the MD community to pursue an MPH career, adding additional public health and health care policy training to the MD workforce. We conducted targeted telephone interviews with 20 admissions personnel and faculty at schools offering MD–MPH degrees in the United States with the highest number of matriculants and graduates. Interviews focused on curricula trends in medical schools that offer an MD–MPH degree. Results No literature describes the US MD–MPH cohort, and available MD–MPH databases are limited and incomplete. We found a 434% increase in the number of students pursuing an MD–MPH degree from 2010 to 2018. The rate of growth was greater than the increase in either the number of medical students (16%) or the number of MPH students (65%) alone. Moreover, MD–MPH students as a percentage of total MPH students more than tripled, from 1.1% in 2010 to 3.6% in 2018. Conclusions As more MD students pursue public health training, the impact of an MPH degree on medical school curricula, MD–MPH graduates, and MD–MPH career pursuits should be studied using accurate and comprehensive databases.

scholarly journals More Than Shelter: Housing for Urban Maternal and Infant Health

2021 ◽  
Vol 18 (7) ◽  
pp. 3331
Author(s):  
Jason Reece
Keyword(s):  
Public Health ◽  
Maternal Health ◽  
Health Outcomes ◽  
City Planning ◽  
Infant Health ◽  
The United States ◽  
Housing Quality ◽  
Housing Discrimination ◽  
Maternal Health Outcomes ◽  
The Impact

Housing quality, stability, and affordability have a direct relationship to socioemotional and physical health. Both city planning and public health have long recognized the role of housing in health, but the complexity of this relationship in regard to infant and maternal health is less understood. Focusing on literature specifically relevant to U.S. metropolitan areas, I conduct a multidisciplinary literature review to understand the influence of housing factors and interventions that impact infant and maternal health. The paper seeks to achieve three primary goals. First, to identify the primary “pathways” by which housing influences infant and maternal health. Second, the review focuses on the role and influence of historical housing discrimination on maternal health outcomes. Third, the review identifies emergent practice-based housing interventions in planning and public health practice to support infant and maternal health. The literature suggests that the impact of housing on infant health is complex, multifaceted, and intergenerational. Historical housing discrimination also directly impacts contemporary infant and maternal health outcomes. Policy interventions to support infant health through housing are just emerging but demonstrate promising outcomes. Structural barriers to housing affordability in the United States will require new resources to foster greater collaboration between the housing and the health sectors.

scholarly journals 1719. Respiratory Syncytial Virus-Associated Hospitalization Rates among US Infants: A Systematic Review and Meta-Analysis

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S843-S843
Author(s):  
John M McLaughlin ◽  
Farid L Khan ◽  
Heinz-Josef Schmitt ◽  
Yasmeen Agosti ◽  
Luis Jodar ◽  
...  
Keyword(s):  
Public Health ◽  
Respiratory Syncytial Virus ◽  
Active Surveillance ◽  
Meta Analysis ◽  
The United States ◽  
Administrative Claims ◽  
Prevention Strategies ◽  
Hospitalization Rates ◽  
Syncytial Virus ◽  
The Impact

Abstract Background Understanding the true magnitude of infant respiratory syncytial virus (RSV) burden is critical for determining the potential public-health benefit of RSV prevention strategies. Although global reviews of infant RSV burden exist, none have summarized data from the United States or evaluated how RSV burden estimates are influenced by variations in study design. Methods We performed a systematic literature review and meta-analysis of studies describing RSV-associated hospitalization rates among US infants. We also examined the impact of key study characteristics on these estimates. Results After review of 3058 articles through January 2020, we identified 25 studies with 31 unique estimates of RSV-associated hospitalization rates. Among US infants < 1 year of age, annual rates ranged from 8.4 to 40.8 per 1000 with a pooled rate= 19.4 (95%CI= 17.9–20.9). Study type was associated with RSV hospitalization rates (P =.003), with active surveillance studies having pooled rates per 1000 (11.1; 95%CI: 9.8–12.3) that were half that of studies based on administrative claims (21.4; 95%CI: 19.5–23.3) or modeling approaches (23.2; 95%CI: 20.2–26.2). Conclusion Applying the pooled rates identified in our review to the 2020 US birth cohort suggests that 73,680 to 86,020 RSV-associated infant hospitalizations occur each year. To date, public-health officials have used conservative estimates from active surveillance as the basis for defining US infant RSV burden. The full range of RSV-associated hospitalization rates identified in our review better characterizes the true RSV burden in infants and can better inform future evaluations of RSV prevention strategies. Disclosures John M. McLaughlin, PhD, Pfizer (Employee, Shareholder) Farid L. Khan, MPH, Pfizer (Employee, Shareholder) Heinz-Josef Schmitt, MD, Pfizer (Employee, Shareholder) Yasmeen Agosti, MD, Pfizer (Employee, Shareholder) Luis Jodar, PhD, Pfizer (Employee, Shareholder) Eric Simões, MD, Pfizer (Consultant, Research Grant or Support) David L. Swerdlow, MD, Pfizer (Employee, Shareholder)

Syphilis epidemiology and public health interventions in Western Australia from 1991 to 2009

Sexual Health ◽  
2012 ◽  
Vol 9 (3) ◽  
pp. 272 ◽  
Author(s):  
Kellie S. H. Kwan ◽  
Carolien M. Giele ◽  
Heath S. Greville ◽  
Carole A. Reeve ◽  
P. Heather Lyttle ◽  
...  
Keyword(s):  
Public Health ◽  
Western Australia ◽  
Aboriginal People ◽  
Congenital Syphilis ◽  
The United States ◽  
Health Interventions ◽  
Public Health Interventions ◽  
Sex With Men ◽  
Notification Data ◽  
The Impact

Objectives To describe the epidemiology of congenital and infectious syphilis during 1991–2009, examine the impact of public health interventions and discuss the feasibility of syphilis elimination among Aboriginal people in Western Australia (WA). Methods: WA congenital and infectious syphilis notification data in 1991–2009 and national infectious syphilis notification data in 2005–2009 were analysed by Aboriginality, region of residence, and demographic and behavioural characteristics. Syphilis public health interventions in WA from 1991–2009 were also reviewed. Results: During 1991–2009, there were six notifications of congenital syphilis (50% Aboriginal) and 1441 infectious syphilis notifications (61% Aboriginal). During 1991–2005, 88% of notifications were Aboriginal, with several outbreaks identified in remote WA. During 2006–2009, 62% of notifications were non-Aboriginal, with an outbreak in metropolitan men who have sex with men. The Aboriginal : non-Aboriginal rate ratio decreased from 173 : 1 (1991–2005) to 15 : 1 (2006–2009). Conclusions: These data demonstrate that although the epidemiology of syphilis in WA has changed over time, the infection has remained endemic among Aboriginal people in non-metropolitan areas. Given the continued public health interventions targeted at this population, the limited success in eliminating syphilis in the United States and the unique geographical and socioeconomic features of WA, the elimination of syphilis seems unlikely in this state.

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