scholarly journals Receipt of Substance Use Counseling Among Ambulatory Patients Prescribed Opioids in the United States

2020 ◽  
Vol 14 ◽  
pp. 117822181989458
Author(s):  
Kirk E Evoy ◽  
Charles E Leonard ◽  
Jordan R Covvey ◽  
Leslie Ochs ◽  
Alyssa M Peckham ◽  
...  
Keyword(s):  
United States ◽  
Substance Use ◽  
Ambulatory Care ◽  
Significant Risk ◽  
Opioid Analgesics ◽  
The United States ◽  
Prescription Opioid ◽  
Cross Sectional ◽  
Increased Risk ◽  
Risk Reduction Measures

Background: As opioid-related overdose deaths climb in the U.S., risk reduction measures are increasingly important. One such measure recommended involves provision of proactive substance use counseling regarding the risks of opioid analgesics. This is particularly important in patients at increased risk of overdose, such as those with substance use disorders (SUD) or those receiving concomitant medications that further increase the overdose risk (eg, benzodiazepines, gabapentinoids, or Z-hypnotics). However, previous research regarding the likelihood that such counseling is provided during outpatient prescriber visits is lacking. Objectives: To determine the percentage of U.S. ambulatory care visits in which patients taking prescription opioids received substance use counseling, and whether counseling was more common in patients with concomitant GABAergic medication(s) (benzodiazepine, gabapentinoid or Z-hypnotic) or substance use disorder (SUD) diagnosis. Methods: A cross-sectional analysis was conducted of all patients aged ⩾18 years identified as having a prescription opioid on their medication list within the 2014-2015 National Ambulatory Medical Care Survey data. Results: Among 162.7 million visits in which patients were taking opioid medication(s), substance use counseling was provided in 2.4%. During visits for patients receiving opioid(s) plus GABAergic(s), substance use counseling was marginally more common (3.1% versus 2.0%, P < .0001). Substance use counseling was also more common among visits for patients taking opioid(s) with SUD (18.9% versus 1.5%, P < .0001). Among visits in which a patient was diagnosed with SUD and taking opioid(s) plus GABAergic(s), counseling was more common (23.1% versus 1.4%, P < .0001) compared to patients taking opioid(s) plus GABAergic(s) without SUD. Conclusions: Among national ambulatory care visits in the United States, substance use counseling is provided infrequently for patients taking opioids, even when significant risk factors are present. Increasing patient education may help reduce opioid-related overdose mortality.

Abuse of reformulated OxyContin: Updated findings from a sentinel surveillance sample of individuals assessed for substance use disorder

2017 ◽  
Vol 13 (6) ◽  
pp. 425 ◽  
Author(s):  
Theresa A. Cassidy, MPH ◽  
Eileen Thorley, MPH ◽  
Ryan A. Black, PhD ◽  
Angela DeVeaugh-Geiss, PhD ◽  
Stephen F. Butler, PhD ◽  
...  
Keyword(s):  
Substance Use ◽  
Substance Use Disorder ◽  
The United States ◽  
Geographic Region ◽  
Addiction Severity Index ◽  
Prescription Opioid ◽  
Cross Sectional ◽  
Geographic Regions ◽  
Drug Problems ◽  
Treatment Settings

Objective: To examine abuse prevalence for OxyContin and comparator opioids over a 6-year period prior to and following market entry of reformulated OxyContin and assess consistency in abuse across treatment settings and geographic regions. Design: An observational study examining longitudinal changes using cross-sectional data from treatment centers for substance use disorder.Setting: A total of 874 facilities in 39 states in the United States within the National Addictions Vigilance Intervention and Prevention Program (NAVIPPRO®) surveillance system.Participants: Adults (72,060) assessed for drug problems using the Addiction Severity Index-Multimedia Version (ASI-MV®) from January 2009 through December 2015 who abused prescription opioids.Main outcome measure(s): Percent change in past 30-day abuse. Results: OxyContin had significantly lower abuse 5 years after reformulation compared to levels for original OxyContin. Consistency of magnitude in OxyContin abuse reductions across geographic regions, ranging from 41 to 52 percent with differences in abuse reductions in treatment setting categories occurred. Changes in geographic region and treatment settings across study years did not bias the estimate of lower OxyContin abuse through confounding.Conclusion: In the postmarket setting, limitations and methodologic challenges in abuse measurement exist and it is difficult to isolate singular impacts of any one intervention given the complexity of prescription opioid abuse. Expectations for a reasonable threshold of abuse for any one ADF product or ADF opioids as a class are still uncertain and undefined. A significant decline in abuse prevalence of reformulated OxyContin was observed 5 years after its reformulation among this treatment sample of individuals assessed for substance use disorder that was lower historically for the original formulation of this product.

scholarly journals Exposure to air pollution and COVID-19 mortality in the United States: A nationwide cross-sectional study

2020 ◽  
Author(s):  
Xiao Wu ◽  
Rachel C Nethery ◽  
M Benjamin Sabath ◽  
Danielle Braun ◽  
Francesca Dominici
Keyword(s):  
United States ◽  
Air Pollution ◽  
Death Rate ◽  
The United States ◽  
Sensitivity Analyses ◽  
List Type ◽  
County Level ◽  
Cross Sectional ◽  
Increased Risk

AbstractObjectivesUnited States government scientists estimate that COVID-19 may kill tens of thousands of Americans. Many of the pre-existing conditions that increase the risk of death in those with COVID-19 are the same diseases that are affected by long-term exposure to air pollution. We investigated whether long-term average exposure to fine particulate matter (PM2.5) is associated with an increased risk of COVID-19 death in the United States.DesignA nationwide, cross-sectional study using county-level data.Data sourcesCOVID-19 death counts were collected for more than 3,000 counties in the United States (representing 98% of the population) up to April 22, 2020 from Johns Hopkins University, Center for Systems Science and Engineering Coronavirus Resource Center.Main outcome measuresWe fit negative binomial mixed models using county-level COVID-19 deaths as the outcome and county-level long-term average of PM2.5 as the exposure. In the main analysis, we adjusted by 20 potential confounding factors including population size, age distribution, population density, time since the beginning of the outbreak, time since state’s issuance of stay-at-home order, hospital beds, number of individuals tested, weather, and socioeconomic and behavioral variables such as obesity and smoking. We included a random intercept by state to account for potential correlation in counties within the same state. We conducted more than 68 additional sensitivity analyses.ResultsWe found that an increase of only 1 μg/m3 in PM2.5 is associated with an 8% increase in the COVID-19 death rate (95% confidence interval [CI]: 2%, 15%). The results were statistically significant and robust to secondary and sensitivity analyses.ConclusionsA small increase in long-term exposure to PM2.5 leads to a large increase in the COVID-19 death rate. Despite the inherent limitations of the ecological study design, our results underscore the importance of continuing to enforce existing air pollution regulations to protect human health both during and after the COVID-19 crisis. The data and code are publicly available so our analyses can be updated routinely.Summary BoxWhat is already known on this topicLong-term exposure to PM2.5 is linked to many of the comorbidities that have been associated with poor prognosis and death in COVID-19 patients, including cardiovascular and lung disease.PM2.5 exposure is associated with increased risk of severe outcomes in patients with certain infectious respiratory diseases, including influenza, pneumonia, and SARS.Air pollution exposure is known to cause inflammation and cellular damage, and evidence suggests that it may suppress early immune response to infection.What this study addsThis is the first nationwide study of the relationship between historical exposure to air pollution exposure and COVID-19 death rate, relying on data from more than 3,000 counties in the United States. The results suggest that long-term exposure to PM2.5 is associated with higher COVID-19 mortality rates, after adjustment for a wide range of socioeconomic, demographic, weather, behavioral, epidemic stage, and healthcare-related confounders.This study relies entirely on publicly available data and fully reproducible, public code to facilitate continued investigation of these relationships by the broader scientific community as the COVID-19 outbreak evolves and more data become available.A small increase in long-term PM2.5 exposure was associated with a substantial increase in the county’s COVID-19 mortality rate up to April 22, 2020.

scholarly journals Home Infusions for Inflammatory Bowel Disease are Safe: United States Experience and Patient Perspectives

2021 ◽  
Author(s):  
Bharati Kochar ◽  
Yue Jiang ◽  
Wenli Chen ◽  
Yuting Bu ◽  
Edward L Barnes ◽  
...  
Keyword(s):  
United States ◽  
Inflammatory Bowel Disease ◽  
Patient Experience ◽  
Bowel Disease ◽  
The United States ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Increased Risk ◽  
Inflammatory Bowel ◽  
States Experience

Abstract Background Home-infusions (HI) for biologic medications are an option for inflammatory bowel disease (IBD) patients in the United States (US). We aimed to describe the population receiving HI and report patient experience with HI. Methods We conducted a retrospective cohort study in the Quintiles-IMSLegacy PharMetrics Adjudicated Claims Database from 2010-2016 to describe the population receiving infliximab and vedolizumab HI and determine predictors for an urgent/emergent visit post-HI. We then administered a cross-sectional survey to IBD-Partners Internet-based cohort participants to assess knowledge and experience with infusions. Results We identified claims for 11,892 conventional infliximab patients, 1,573 home infliximab patients, 438 conventional vedolizumab patients and 138 home vedolizumab patients. There were no differences in demographics or median charges with infliximab home and conventional infusions. Home vedolizumab infusions had a greater median charge than conventional vedolizumab infusion. Less than 4% of patients had an urgent/emergent visit post-HI. Charlson comorbidity index &gt;0 (OR:1.95, 95% CI:1.01-3.77) and Medicaid (OR:3.01, 95%CI:1.53-5.94) conferred significantly higher odds of urgent/emergent visit post-HI. In IBD-Partners, 644 IBD patients responded; 56 received HI. The majority chose HI to save time and preferred HI to conventional infusions. Only 2 patients reported an urgent/emergent visit for HI-related problems. Conclusions HI appears to be safe in IBD patients receiving infliximab and vedolizumab. However, patients with fewer resources and more co-morbidities are at increased risk for an urgent/emergent visit post-HI. The overall patient experience with HI is positive. Expansion of HI may result in decreased therapy-related logistic burden for carefully selected patients.

scholarly journals Greater Acculturation is Associated With Poorer Cardiovascular Health in the Multi‐Ethnic Study of Atherosclerosis

2021 ◽  
Author(s):  
Olatokunbo Osibogun ◽  
Oluseye Ogunmoroti ◽  
Lena Mathews ◽  
Victor Okunrintemi ◽  
Martin Tibuakuu ◽  
...  
Keyword(s):  
United States ◽  
Cardiovascular Disease ◽  
Cardiovascular Health ◽  
Hispanic Americans ◽  
The United States ◽  
Foreign Born ◽  
Cross Sectional ◽  
Lower Odds ◽  
Increased Risk ◽  
At Home

Background Greater acculturation is associated with increased risk of cardiovascular disease. However, little is known about the association between acculturation and ideal cardiovascular health (CVH) as measured by the American Heart Association's 7 CVH metrics. We investigated the association between acculturation and ideal CVH among a multi‐ethnic cohort of US adults free of clinical cardiovascular disease at baseline. Methods and Results This was a cross‐sectional analysis of 6506 men and women aged 45 to 84 years of 4 races/ethnicities. We examined measures of acculturation(birthplace, language spoken at home, and years lived in the United States [foreign‐born participants]) by CVH score. Scores of 0 to 8 indicate inadequate, 9 to 10 average and 11 to 14 optimal CVH. We used multivariable regression to examine associations between acculturation and CVH, adjusting for age, sex, race/ethnicity, education, income and health insurance. The mean (SD) age was 62 (10) years, 53% were women, 39% non‐Hispanic White‐, 26% non‐Hispanic Black‐, 12% Chinese‐ and 22% Hispanic‐Americans. US‐born participants had lower odds of optimal CVH (odds ratio [OR]: 0.63 [0.50–0.79], P <0.001) compared with foreign‐born participants. Participants who spoke Chinese and other foreign languages at home had greater odds of optimal CVH compared with those who spoke English (1.91 [1.08–3.36], P =0.03; and 1.65 [1.04–2.63], P =0.03, respectively). Foreign‐born participants who lived the longest in the United States had lower odds of optimal CVH (0.62 [0.43–0.91], P =0.02). Conclusions Greater US acculturation was associated with poorer CVH. This finding suggests that the promotion of ideal CVH should be encouraged among immigrant populations since more years lived in the United States was associated with poorer CVH.

scholarly journals Prescription Drug Monitoring Programs and Prescription Opioid–Related Outcomes in the United States

2020 ◽  
Author(s):  
Victor Puac-Polanco ◽  
Stanford Chihuri ◽  
David S Fink ◽  
Magdalena Cerdá ◽  
Katherine M Keyes ◽  
...  
Keyword(s):  
United States ◽  
Substance Use ◽  
Prescription Drug ◽  
Substance Use Disorders ◽  
Drug Monitoring ◽  
The United States ◽  
Mortality Rates ◽  
Prescription Opioid ◽  
Prescription Drug Monitoring Programs ◽  
Opioid Diversion

Abstract Prescription drug monitoring programs (PDMPs) are a crucial component of federal and state governments’ response to the opioid epidemic. Evidence about the effectiveness of PDMPs in reducing prescription opioid–related adverse outcomes is mixed. We conducted a systematic review to examine whether PDMP implementation within the United States is associated with changes in 4 prescription opioid–related outcome domains: opioid prescribing behaviors, opioid diversion and supply, opioid-related morbidity and substance-use disorders, and opioid-related deaths. We searched for eligible publications in Embase, Google Scholar, MEDLINE, and Web of Science. A total of 29 studies, published between 2009 and 2019, met the inclusion criteria. Of the 16 studies examining PDMPs and prescribing behaviors, 11 found that implementing PDMPs reduced prescribing behaviors. All 3 studies on opioid diversion and supply reported reductions in the examined outcomes. In the opioid-related morbidity and substance-use disorders domain, 7 of 8 studies found associations with prescription opioid–related outcomes. Four of 8 studies in the opioid-related deaths domain reported reduced mortality rates. Despite the mixed findings, emerging evidence supports that the implementation of state PDMPs reduces opioid prescriptions, opioid diversion and supply, and opioid-related morbidity and substance-use disorder outcomes. When PDMP characteristics were examined, mandatory access provisions were associated with reductions in prescribing behaviors, diversion outcomes, hospital admissions, substance-use disorders, and mortality rates. Inconsistencies in the evidence base across outcome domains are due to analytical approaches across studies and, to some extent, heterogeneities in PDMP policies implemented across states and over time.

The Association of Federal and State-level Firearm Restriction Policies With Intimate Partner Homicide: A Re-analysis by Race of the Victim

2021 ◽  
pp. 088626052110219
Author(s):  
Mikaela A. Wallin ◽  
Charvonne N. Holliday ◽  
April M. Zeoli
Keyword(s):  
United States ◽  
Significant Risk ◽  
State Level ◽  
The United States ◽  
Intimate Partner ◽  
Future Research ◽  
Intimate Partner Homicide ◽  
Cross Sectional ◽  
Black Populations ◽  
The Impact

Firearms present a significant risk of intimate partner homicide (IPH) among women in the United States, and Black women continue to be overrepresented among IPH fatalities. State-level firearm restrictions for individuals under domestic violence restraining orders (DVRO) and firearm restrictions for those convicted of violent misdemeanor crimes are associated with reductions in IPH. To receive these protections, individuals must engage with the civil or criminal justice system. While access to, and engagement with, these systems may differ between Black and White populations, research has yet to examine the impact of these firearm restriction laws on IPH by racial group. We conducted pooled, cross-sectional, time-series analyses to examine the association of selected firearm restriction laws on IPH by the race of the victims, from 1981 to 2013 for 45 states in the United States. State-level DVRO firearm restrictions were associated with reductions in IPH in the White population only. The inclusion of relinquishment provisions in state DVRO firearm laws is associated with an 11% reduction in IPH and a 16% reduction in firearm IPH for White, but not Black, victims. Similarly, laws prohibiting individuals convicted of violent misdemeanors from possessing firearms are associated with a 23% reduction in IPH and a 28% reduction in firearm IPH for White victims only. The federal DVRO firearm restriction law is associated with a 27% reduction in state-level IPH and a 28% reduction in firearm IPH for Black, but not White, victims. Firearm restriction laws may have a limited impact on IPH in Black populations. Future research should examine the factors behind the differential estimated impact of these laws by the race of the victims.

“You’re Ganja Have a Good Time”: Investigating the Roots of Blunt Use Among a National Sample of Hispanic Adults

2019 ◽  
Vol 18 (1) ◽  
pp. 20-26
Author(s):  
R. Andrew Yockey ◽  
Keith A. King ◽  
Rebecca A. Vidourek
Keyword(s):  
Risk Factors ◽  
Substance Use ◽  
Significant Risk ◽  
Public Health Problem ◽  
The United States ◽  
Good Time ◽  
Assistance Program ◽  
Factors Associated ◽  
Increased Risk ◽  
Hispanic Adults

Blunt use is a pressing public health problem in the United States. While most studies have focused on African American youth, there remains a paucity of research examining blunt use among Hispanic individuals. Previous findings, which are quite limited, suggest mixed results, thus warranting further investigation regarding the prevalence of blunt use among Hispanic individuals and factors associated with such use. In accord with Jessor’s problem behavior theory, we hypothesized that prior use of illicit substances and certain psychosocial risk factors pose an increased risk for blunt use among Hispanic adults. A secondary analysis examined prior substance use and psychosocial factors of 10,216 Hispanic lifetime blunt users participating in the 2017 National Survey on Drug Use and Health. Findings revealed that one in five (20.5%) Hispanic individuals reported lifetime blunt use. Significant risk factors associated with blunt use were age (18+ years or older), participation in a government assistance program, prior illicit substance use, and changes in appetite or weight. Additional research on other risk factors, prevention mechanisms, and treatment interventions for Hispanic individuals who use blunts is warranted.

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