scholarly journals Drug use, homelessness and health: responding to the opioid overdose crisis with housing and harm reduction services

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Katrina Milaney ◽  
Jenna Passi ◽  
Lisa Zaretsky ◽  
Tong Liu ◽  
Claire M. O’Gorman ◽  
...  
Keyword(s):  
Drug Use ◽  
Harm Reduction ◽  
Housing Instability ◽  
Opioid Overdose ◽  
Opioid Use ◽  
Chi Square ◽  
Increased Risk ◽  
Reported Data ◽  
Structural Inequities ◽  
Hospital Use

Abstract Background Canada is in the midst of an opioid overdose crisis and Alberta has one of the highest opioid use rates across the country. Populations made vulnerable through structural inequities who also use opioids, such as those who are unstably housed, are at an increased risk of experiencing harms associated with opioid use. The main purpose of this study was to explore if there was an association between unstable housing and hospital use for people who use opioids. Methods Analysis utilized self-reported data from the Alberta Health and Drug Use Survey which surveyed 813 Albertans in three cities. Hospital use was modeled using a logistic regression with our primary variable of interest being housing unstable status. Chi square tests were conducted between hospital use and variables associated with demographics, characteristics of drug use, health characteristics, and experiences of receiving services to establish model inclusion. Results Results revealed a significant association between housing instability and hospital use with unstably housed individuals twice as likely torequire hospital care. Conclusions Results highlight the importance of concurrently addressing housing instability alongside the provision of harm reduction services such as safe supply and supervised consumption sites. These findings have significant implications for policy and policymakers during the opioid overdose epidemic, and provide a foundation for future areas of research.

scholarly journals Drug Use, Homelessness and Health: Responding to the Opioid Overdose Crisis with Housing and Harm Reduction Services

2021 ◽  
Author(s):  
katrina milaney
Keyword(s):  
Drug Use ◽  
Harm Reduction ◽  
Housing Instability ◽  
Opioid Overdose ◽  
Opioid Use ◽  
Chi Square ◽  
Increased Risk ◽  
Reported Data ◽  
Structural Inequities ◽  
Hospital Use

Abstract Background Canada is in the midst of an opioid overdose crisis and Alberta has one of the highest opioid use rates across the country. Populations made vulnerable through structural inequities who also use opioids, such as those who are unstably housed, are at an increased risk of experiencing harms associated with opioid use. The main purpose of this study was to explore if there was an association between unstable housing and hospital use for people who use opioids. Methods Analysis utilized self-reported data from the Alberta Health and Drug Use Survey which surveyed 813 Albertans in three cities. Hospital use was modeled using a logistic regression with our primary variable of interest being housing unstable status. Chi square tests were conducted between hospital use and variables associated with demographics, characteristics of drug use, health characteristics, and experiences of receiving services to establish model inclusion. Results Results revealed a significant association between housing instability and hospital use.with unstably housed individuals twice as likely torequire hospital care. Conclusions Results highlight the importance of concurrently addressing housing instability alongside the provision of harm reduction services such assafe supply and supervised consumption sites. These findings have significant implications for policy and policymakers during the opioid overdose epidemic, and provide a foundation for future areas of research.

scholarly journals Drug Use, Homelessness and Health: Responding to The Opioid Overdose Crisis with Housing First Models

2020 ◽  
Author(s):  
Katrina Milaney ◽  
Jenna Passi ◽  
Lisa Zaretsky ◽  
Tong Liu ◽  
Claire M O'Gorman ◽  
...  
Keyword(s):  
Drug Use ◽  
Housing First ◽  
Housing Instability ◽  
Opioid Overdose ◽  
Opioid Use ◽  
Chi Square ◽  
Increased Risk ◽  
Reported Data ◽  
Structural Inequities ◽  
Hospital Use

Abstract Background: Canada is in the midst of an opioid overdose crisis and Alberta has one of the highest opioid use rates across the country. Populations made vulnerable through structural inequities who also use opioids, such as those who are unstably housed, are at an increased risk of experiencing harms associated with opioid use. The main purpose of this study was to explore if there was an association between unstable housing and hospital use for people who use opioids. Methods: Analysis utilized self-reported data from the Alberta Health and Drug Use Survey which surveyed 813 Albertans in three cities. Hospital use was modeled using a logistic regression with our primary variable of interest being housing unstable status. Chi square tests were conducted between hospital use and variables associated with demographics, characteristics of drug use, health characteristics, and experiences of receiving services to establish model inclusion. Results: Results revealed a significant association between housing instability and hospital use, with unstably housed individuals twice as likely to become hospital users. Conclusions: Results highlight the importance of concurrently addressing housing instability alongside the provision of harm reduction services such as Housing First programs and supervised consumption sites. These findings have significant implications for policy and policymakers during the opioid overdose epidemic, and provide a foundation for future areas of research.

Abstract 228: National Prevalence of Substance Use Disorders Among Hospitalized Heart Failure Patients

2018 ◽  
Vol 11 (suppl_1) ◽  
Author(s):  
Sarah C Snow ◽  
Gregg C Fonarow ◽  
Joseph A Ladapo ◽  
Donna L Washington ◽  
Katherine Hoggatt ◽  
...  
Keyword(s):  
Heart Failure ◽  
Substance Use ◽  
Native American ◽  
Drug Use ◽  
Substance Use Disorders ◽  
Age Groups ◽  
Opioid Use ◽  
Drug Use Disorders ◽  
Increased Risk ◽  
Drug Use Disorder

Background: Several cardiotoxic substances contribute to the development of heart failure (HF). The burden of comorbid substance use disorders (SUD) among patients with HF is under-characterized. Objectives: To describe the national burden of comorbid SUD (tobacco, alcohol, or drug use disorders) among hospitalized HF patients in the U.S. Methods: We used data from the 2014 National Inpatient Sample to calculate the proportion of hospitalizations for a primary HF admission with tobacco, alcohol, or drug use disorder diagnoses, accounting for demographic factors. Drug use disorder analysis was further sub-divided into specific illicit substance categories. Results: There were a total of 989,080 HF hospitalizations of which 35.3% (n=348,995) had a documented SUD. Tobacco use disorder (TUD) was most common (n= 327,220, 33.1%) followed by drug use disorder (DUD) (n=34,600, 3.5%) and alcohol use disorder (AUD) (n=34,285, 3.5%). Female sex was associated with less TUD (OR 0.59; 95% CI, 0.58-0.60), AUD (OR 0.23; 95% CI, 0.22-0.25) or DUD (OR 0.58; 95% CI 0.55-0.62). Tobacco, alcohol, cocaine, and opioid use disorders were highest among HF patients age 45 to 55, while cannabis and amphetamine use was highest in those <45 years. Native American race (versus White) was associated with increased risk of AUD (OR 1.67; 95% CI 1.27-2.20). Black race was associated with increased risk of AUD (OR 1.09; 95% CI 1.02-1.16) or DUD (OR 1.63; 95% CI 1.53-1.74). Medicaid insurance (versus Medicare) was associated with greater TUD (OR 1.27; 95% CI 1.23-1.32), AUD (OR 1.74; 95% CI 1.62-1.87), and DUD (OR 2.15; 95% CI 2.01-2.30). Decreasing quartiles of median household income were associated with increasing SUD. Conclusions: Comorbid SUD disproportionately affects certain HF populations, including men, younger age groups, lower SES patients, and race/ethnic minorities. Further research on interventions to improve prevention and treatment of SUD among hospitalized HF patients are needed given the high rates of SUD in this population. Systematically screening hospitalized HF patients for SUD may reveal opportunities for treatment and secondary prevention.

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.

A cohort analysis of illicit psychoactive drug use in Australia 1988-98

2001 ◽  
Vol 13 ◽  
pp. 1-12 ◽  
Author(s):  
Paul Williams ◽  
Ian McAllister
Keyword(s):  
Drug Use ◽  
Illicit Drugs ◽  
Cohort Analysis ◽  
Psychoactive Drug ◽  
Birth Cohorts ◽  
Chi Square ◽  
Post Secondary ◽  
National Drug ◽  
Increased Risk ◽  
Regression Techniques

AbstractObjective: To examine birth cohort trends in the prevalence, age of initiation and durability of the use of psycho-stimulant and psycho-depressant drugs in Australia between 1988 and 1998.Method: Nine synthetic birth cohorts were constructed from a pooled dataset of the three National Drug Strategy Household Surveys (1988, 1993, 1998). The design-effect adjusted weighted lifetime and recent prevalence, age of initiation and durability of use, of three popular psycho-stimulants (amphetamine, cocaine and ecstasy) and three popular psycho-depressants (cannabis, heroin and inhalants) were estimated. Significance tests of difference use chi-square statistics and the sociodemographic predictors of trends were tested using logistic regression techniques.Results: Lifetime and recent prevalence and durability of use increased and ages of initiation decreased, with each successive cohort. Psycho-stimulants were predictors for psycho-depressant use and vice versa. Being male, aged under 35 years, Australian born, employed or in fulltime education, and a tobacco smoker were significant predictors of increased risk of using both classes of drugs. Being married or having no post-secondary education qualifications were significant predictors of lower risk of using either class of drugs.Conclusions: Younger cohorts are more likely to use both classes of psychoactive drugs, to have commenced using the drugs earlier and to have maintained their drug habits longer, compared to older cohorts. While increased availability is an important factor in the likelihood of exposure to illicit drugs, interventions implemented since the National Drug Strategy began in 1985 do not appear to have reduced the probability that young people will initiate and maintain illicit psychoactive drug use, exposing them to associated health and legal consequences.

Opioid Use Disorder during Antepartum and Postpartum Hospitalizations

2019 ◽  
Vol 37 (14) ◽  
pp. 1467-1475
Author(s):  
Adina R. Kern-Goldberger ◽  
Yongmei Huang ◽  
Melanie Polin ◽  
Zainab Siddiq ◽  
Jason D. Wright ◽  
...  
Keyword(s):  
Opioid Dependence ◽  
Nationwide Inpatient Sample ◽  
Temporal Trends ◽  
Opioid Use Disorder ◽  
Opioid Overdose ◽  
Opioid Use ◽  
Chi Square ◽  
Cross Sectional ◽  
Chi Square Test ◽  
Sectional Analysis

Objective This study aimed to evaluate temporal trends in opioid use disorder (OUD) during antepartum and postpartum hospitalizations. Study Design This repeated cross-sectional analysis analyzed data from the National (Nationwide) Inpatient Sample. Women aged 15 to 54 years admitted antepartum or postpartum were identified. The presence of OUD was determined based on a diagnosis of opioid abuse, opioid dependence, or opioid overdose. Temporal trends in OUD were evaluated using the Rao–Scott chi-square test. Temporal trends in opioid overdose were additionally evaluated. Results An estimated 7,336,562 antepartum hospitalizations and 1,063,845 postpartum readmissions were included in this analysis. The presence of an OUD diagnosis during antepartum hospitalizations increased from 0.7% of patients in 1998 to 1999 to 2.9% in 2014 (p < 0.01) and during postpartum hospitalizations increased from 0.8% of patients in 1998 to 1999 to 2.1% of patients in 2014 (p < 0.01). Risk of overdose diagnoses increased significantly for both antepartum hospitalizations, from 22.7 per 100,000 hospitalizations in 1998 to 2000 to 70.3 per 100,000 hospitalizations in 2013 to 2014 (p < 0.001), and postpartum hospitalizations, from 18.8 per 100,000 hospitalizations in 1998 to 2000 to 65.2 per 100,000 hospitalizations in 2013 to 2014 (p = 0.02). Discussion Risk of OUD diagnoses and overdoses increased over the study period for both antepartum and postpartum hospitalizations.

scholarly journals Implementation of Buprenorphine Services in NYC Syringe Services Programs: a qualitative process evaluation

2021 ◽  
Author(s):  
Andrea Jakubowski ◽  
Caroline Rath ◽  
Alex Harocopos ◽  
Monique Wright ◽  
Alice Welch ◽  
...  
Keyword(s):  
Harm Reduction ◽  
Technical Assistance ◽  
Opioid Overdose ◽  
Health Departments ◽  
Psychosocial Needs ◽  
Opioid Use ◽  
Treatment Access ◽  
Stage Of Development ◽  
Low Threshold ◽  
Buprenorphine Treatment

Abstract Background Syringe services programs (SSPs) hold promise for providing buprenorphine treatment access to people with opioid use disorder (OUD) who are reluctant to seek care elsewhere. In 2017, the New York City Department of Health and Mental Hygiene (DOHMH) provided funding and technical assistance to nine SSPs to develop “low-threshold” buprenorphine services as part of a multipronged initiative to lower opioid-related overdose rates. The aims of this study were to 1) Describe characteristics of SSP-based buprenorphine services; and 2) Identify barriers to and facilitators of implementing SSP-based buprenorphine services. Methods We conducted 26 semi-structured qualitative interviews from April 2019 - November 2019 at eight SSPs in NYC that received funding and technical assistance from DOHMH. Interviews were conducted with three categories of staff: leadership (8 interviews); staff (11), and providers (6). We used thematic analysis to identify themes within pre-identified domains: program characteristics and barriers and facilitators to program implementation. We make recommendations for implementation based on our findings. Results Programs differed in their stage of development, location of services provided, and provider type, availability, and practices. Barriers to providing buprenorphine services at SSPs included gaps in staff knowledge and comfort communicating with participants about buprenorphine, difficulty hiring providers, managing tension between harm reduction and traditional OUD treatment philosophies, and financial constraints. Challenges also arose from serving a population with unmet psychosocial needs. Implementation facilitators included technical assistance from DOHMH, designated buprenorphine coordinators, offering other supportive services to participants, and telehealth to bridge gaps in provider availability. Key recommendations include: 1) health departments should provide support for SSPs in training staff, building health service infrastructure and developing policies and procedures, 2) SSPs should designate a buprenorphine coordinator and ensure regular training on buprenorphine for their frontline staff, and 3) providers should be selected or supported to use a harm reduction approach to buprenorphine treatment. Conclusions Despite encountering challenges, eight SSPs implemented buprenorphine services outside of conventional OUD treatment settings. Our findings have implications for health departments, SSPs, and other community organizations implementing buprenorphine services. Expansion of low-threshold buprenorphine services is a promising strategy to address the opioid overdose epidemic.

An association between tobacco smoking, daily opioid use, pain response and the risk for aberrant opioid use behaviors.

2018 ◽  
Vol 36 (34_suppl) ◽  
pp. 226-226
Author(s):  
Sriram J. Yennu ◽  
Tonya Edwards ◽  
Zhanni Lu ◽  
Janet L. Williams ◽  
Joseph Anthony Arthur ◽  
...  
Keyword(s):  
Drug Use ◽  
Supportive Care ◽  
Cancer Patients ◽  
Tobacco Smoking ◽  
Illicit Drug ◽  
Smoking History ◽  
Pain Response ◽  
Opioid Use ◽  
Increased Risk ◽  
Never Smokers

226 Background: Opioid misuse is a growing crisis. Cancer patients at risk of aberrant drug behaviors are frequently underdiagnosed. Primary aim was to determine the association between current tobacco smoking, daily opioid use, pain response, and risk for aberrant opioid use behaviors (AOB) among patients receiving outpatient supportive care consultation at a comprehensive cancer center. Methods: 1,501 consecutive cancer patients referred to a supportive care clinic from March 1, 2016 to June 6, 2018 were reviewed. Patients were eligible if they had diagnosis of cancer, and were on opioids for pain for at least a week. All patients were assessed using Edmonton Symptom Assessment Scale (ESAS), SOAPP-14 (validated questionnaire for assessment of risk for aberrant opioid use behaviors), and CAGE-AID. Patients with AOB (SOAPP+) were defined by SOAPP score ≥7. Results: Median age was 61yrs. Median ESAS pain item score on consultation was 5. Median ECOG was 2. Never smokers, previous smokers, and current smokers were 54%, 40%, and 6.6% respectively. 16.8% were AOB+ and 10.1% were CAGE-AID+. There was no significant difference in ESAS pain response at first follow-up between AOB+ versus AOB negative. Morphine Equivalent Daily Dose (MEDD) in AOB+ never smokers versus previous smokers versus current smokers was 45 mg versus 60 mg versus 75mg respectively (P=0.03). Table 1 shows that male pts and those with current or previous smoking history, anxiety, and prior alcoholism/illicit drug use are at increased risk of AOB. Conclusions: Male patients and those with history of current or previous smoking history, anxiety, and prior alcoholism/illicit drug use are at increased risk of AOB. [Table: see text]

scholarly journals Preventing opioid overdose with peer-administered naloxone: findings from a rural state

2020 ◽  
Vol 17 (1) ◽  
Author(s):  
Bridget L. Hanson ◽  
Rebecca R. Porter ◽  
Amanda L. Zöld ◽  
Heather Terhorst-Miller
Keyword(s):  
Drug Use ◽  
Opioid Use Disorder ◽  
Opioid Overdose ◽  
Opioid Use ◽  
Policy Improvement ◽  
Heroin Users ◽  
Overdose Prevention ◽  
Overdose Death ◽  
High Satisfaction ◽  
Rural State

Abstract Background In response to the opioid epidemic, naloxone distribution programs aim to prevent overdose death by making naloxone available and training people to use it. Peers of individuals at risk of opioid overdose are well-positioned to administer naloxone and prevent overdose death. Methods We conducted key informant interviews with 18 individuals with past or current opioid and heroin drug use who had administered naloxone to a peer during an overdose emergency. Interviews explored individuals’ experiences with administration and their recommendations for program and policy improvement. Data were systematically coded and analyzed for themes. Results Participants sought naloxone rescue kits because they perceived high risk of overdose. They described high satisfaction with training and felt prepared to administer naloxone during overdose incidents. Overwhelmingly, participants perceived naloxone to be effective and emphasized the need to make it widely available. Findings suggest that engagement in overdose prevention strategies other than naloxone differs by gender, with females more likely than males to use multiple different strategies. Participants described that overdose experiences do not have a lasting impact on drug use behaviors. Conclusions Findings support the feasibility of naloxone distribution to peer opioid and heroin users and provide recommendations for policy improvement, including effective and well-advertised Good Samaritan laws and links to treatment for opioid use disorder.

scholarly journals 2900. High Rates of Experienced and Witnessed Opioid Overdose in PWID Receiving HCV Treatment: Data From the ANCHOR Study

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S83-S83
Author(s):  
Elana S Rosenthal ◽  
Laura Nussdorf ◽  
Aaron D’Amore ◽  
Christopher Brokus ◽  
Rachel Silk ◽  
...  
Keyword(s):  
Harm Reduction ◽  
Opioid Use Disorder ◽  
Morbidity And Mortality ◽  
Opioid Overdose ◽  
Opioid Use ◽  
Hcv Treatment ◽  
Single Center Study ◽  
Treatment Data ◽  
Evidenced Based ◽  
Chronic Hcv

Abstract Background People who inject drugs (PWID) have significant morbidity and mortality associated with hepatitis C (HCV); however, harms associated with ongoing injecting drug use (IDU)—such as opioid overdose—may pose a more imminent risk, and often are not addressed as part of HCV treatment. Naloxone distribution is a simple, evidenced-based strategy to reduce mortality associated with opioid overdose. Methods ANCHOR is a single-center study embedded in an urban harm-reduction program evaluating treatment of HCV in PWID with chronic HCV, opioid use disorder (OUD), and IDU. Participants received HCV treatment and were offered collocated buprenorphine. At each study visit, patients self-reported experienced and witnessed overdose and were offered naloxone. Results The 100 enrolled participants are predominantly male (75%), median 57 years, black (93%) and inject opioids at least daily (58%). At baseline, 65% had ever experienced overdose, 91% had ever witnessed an overdose, and 35% had ever administered naloxone. Between day 0 and week 48, 15 patients (15%) experienced overdose; of which, 4 (4%) were fatal. The rate of experienced overdose was 15 overdoses per 100 person-years. In addition, 59 (59%) patients witnessed at least one overdose between day 0 and week 48. Seventy-three patients were dispensed naloxone at least once, and of those who witnessed an overdose, 48 (81%) administered naloxone. Nineteen (40%) patients who administered naloxone had never used naloxone before starting HCV treatment. Conclusion PWID with HCV, OUD, and ongoing IDU have high rates of personal and witnessed overdose during and after HCV treatment. Dispensing naloxone at HCV-related visits is highly acceptable among PWID, and results in high rates of naloxone utilization. To reduce morbidity and mortality in patients and their communities, ID providers should complement treatment of infections by prescribing naloxone for patients with OUD, ideally as part of a comprehensive package of harm reduction and OUD treatment. Disclosures All Authors: No reported Disclosures.

Sign in / Sign up

Export Citation Format

Share Document