scholarly journals Predicting the Impact of Placing an Overdose Prevention Site in Philadelphia: A Mathematical Modeling Approach

2021 ◽  
Author(s):  
Joanna R. Wares ◽  
Jing Dong ◽  
Jana L. Gevertz ◽  
Ami Radunskaya ◽  
Kendra Viner ◽  
...  
Keyword(s):  
Mathematical Modeling ◽  
Indirect Effects ◽  
Population Distribution ◽  
Health Impact ◽  
The United States ◽  
Opioid Use ◽  
Overdose Prevention ◽  
User Behaviors ◽  
Substance Disorders ◽  
The Impact

Abstract Background: Fatal overdoses from opioid use and substance disorders are increasing at an alarming rate. One proposed harm reduction strategy for reducing overdose fatalities is to place overdose prevention sites - commonly known as safe injection facilities - in proximity of locations with the highest rates of overdose. As urban centers in the United States are tackling legal hurdles and community skepticism around the introduction and location of these sites, it becomes increasingly important to present compelling evidence of impact and safety. Methods: We developed a mathematical model to describe the movement of opioid users to an overdose prevention site in order to understand the impact that the facility would have on overdoses, fatalities, and user education and recovery. The discrete-time, stochastic model is able to describe a range of user behaviors, including the effects from how far they need to travel to the site. We calibrated the model to overdose data from Philadelphia, and ran simulations to describe the effect of placing a site in the Kensington neighborhood.Results: In Philadelphia, which has a non-uniform racial population distribution, choice of site placement can determine which demographic groups are most helped. In our simulations, placement of the site in the Kensington neighborhood resulted in disproportionate benefits for white users. Simulations also predict that direct effects from overdose reversal in the overdose prevention site are small (about 6 fewer fatalities per year per 30 spots at the overdose prevention site without other effects). However, fatalities and nonfatal overdoses are predicted to decrease substantially when indirect effects from site safety and education of users are considered. Conclusions: Cities and locales can use mathematical modeling to help quantify the predicted impact of placing an opioid prevention site in a particular location. To fully understand the impact of site placement, it is recommended to include both direct and indirect effects in analysis. Introducing more than one site and distributing sites equally across neighborhoods with different racial and demographic characteristics would have the broadest public health impact.

scholarly journals Predicting the impact of placing an overdose prevention site in Philadelphia: a mathematical modeling approach

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Joanna R. Wares ◽  
Jing Dong ◽  
Jana L. Gevertz ◽  
Ami Radunskaya ◽  
Kendra Vine ◽  
...  
Keyword(s):  
Public Health ◽  
Mathematical Modeling ◽  
Population Distribution ◽  
Health Impact ◽  
Opioid Use ◽  
Overdose Prevention ◽  
User Behaviors ◽  
Substance Disorders ◽  
The Usa ◽  
The Impact

Abstract Background Fatal overdoses from opioid use and substance disorders are increasing at an alarming rate. One proposed harm reduction strategy for reducing overdose fatalities is to place overdose prevention sites—commonly known as safe injection facilities—in proximity of locations with the highest rates of overdose. As urban centers in the USA are tackling legal hurdles and community skepticism around the introduction and location of these sites, it becomes increasingly important to assess the magnitude of the effect that these services might have on public health. Methods We developed a mathematical model to describe the movement of people who used opioids to an overdose prevention site in order to understand the impact that the facility would have on overdoses, fatalities, and user education and treatment/recovery. The discrete-time, stochastic model is able to describe a range of user behaviors, including the effects from how far they need to travel to the site. We calibrated the model to overdose data from Philadelphia and ran simulations to describe the effect of placing a site in the Kensington neighborhood. Results In Philadelphia, which has a non-uniform racial population distribution, choice of site placement can determine which demographic groups are most helped. In our simulations, placement of the site in the Kensington neighborhood resulted in White opioid users being more likely to benefit from the site’s services. Overdoses that occur onsite can be reversed. Our results predict that for every 30 stations in the overdose prevention site, 6 per year of these would have resulted in fatalities if they had occurred outside of the overdose prevention site. Additionally, we estimate that fatalities will decrease further when referrals from the OPS to treatment are considered. Conclusions Mathematical modeling was used to predict the impact of placing an overdose prevention site in the Kensington neighborhood of Philadelphia. To fully understand the impact of site placement, both direct and indirect effects must be included in the analysis. Introducing more than one site and distributing sites equally across neighborhoods with different racial and demographic characteristics would have the broadest public health impact. Cities and locales can use mathematical modeling to help quantify the predicted impact of placing an overdose prevention site in a particular location.

Preparing pharmacists to increase naloxone dispensing within community pharmacies under the Pennsylvania standing order

2020 ◽  
Author(s):  
Heather M Santa ◽  
Samira G Amirova ◽  
Daniel J Ventricelli ◽  
George E Downs ◽  
Alexandra A Nowalk ◽  
...  
Keyword(s):  
Community Pharmacists ◽  
The United States ◽  
Health Concern ◽  
Community Pharmacies ◽  
Opioid Overdose ◽  
Patient Counseling ◽  
Opioid Use ◽  
Overdose Prevention ◽  
Standing Order ◽  
Overdose Deaths

Abstract Purpose Opioid misuse and overdose deaths remain a public health concern in the United States. Pennsylvania has one of the highest rates of opioid overdose deaths in the country, with Philadelphia County’s being 3 times higher than the national average. Despite several multimodal interventions, including use of SBIRT (screening, brief intervention, and referral to treatment) methods and naloxone distribution, the rate of overdose deaths remains high. Methods To gain insights on strategies for improving access to naloxone and naloxone distribution by pharmacists in Philadelphia County, a study was conducted in 11 community pharmacies (chain and independent) in Philadelphia. Twenty-four pharmacists were recruited and completed SBIRT and naloxone trainings. Each pharmacy elected to have at least 1 pharmacy champion who received additional training on and helped develop pharmacy site–specific naloxone dispensing protocols. Results Pre-post survey results showed a reduction in stigmatizing attitudes regarding naloxone dispensing and an increase in pharmacists’ understanding of the standing order and appropriate naloxone use. There was an increase in pharmacists’ self-reported confidence in their ability to appropriately identify, discuss, and dispense naloxone to patients. All pharmacies increased their average monthly dispensing rate following protocol implementation. Conclusion Pharmacists who received both trainings were more likely to change naloxone dispensing practices, leading to an overall increase in naloxone dispensing by community pharmacists. The study addressed overall gaps in pharmacists’ knowledge, reduced stigma, and prepared pharmacists to address opioid use and overdose prevention with their patients. The described pharmacist-led patient counseling and intervention service for overdose prevention may be explored as a model for other community pharmacies to adopt to improve naloxone dispensing and similar interventions to reduce overdose deaths.

Multimodal Analgesia and Decreased Opioid Use in Adult Trauma Patients

2020 ◽  
Vol 86 (8) ◽  
pp. 950-954
Author(s):  
Andrew L. Drahos ◽  
Anthony M. Scott ◽  
Tracy J. Johns ◽  
Dennis W. Ashley
Keyword(s):  
Acute Kidney Injury ◽  
Management Strategies ◽  
Kidney Injury ◽  
Multimodal Analgesia ◽  
The United States ◽  
Control Group ◽  
Trauma Patients ◽  
Opioid Use ◽  
Trauma Service ◽  
The Impact

Background There is an opioid epidemic in the United States. With the increased concern of over-prescribing opioids, physicians are seeking alternative pain management strategies. The purpose of this study is to review the impact of instituting a multimodal analgesia (MMA) guideline on decreasing opioid use in trauma patients at a Level 1 trauma center. Methods In 2017, an MMA guideline was developed and included anti-inflammatories, muscle relaxants, neuropathic agents, and local analgesics in addition to opioids. Staff were educated and the guideline was implemented. A retrospective review of medications prescribed to patients admitted from 2016 through 2018 was performed. Patients admitted in 2016 served as the control group (before MMA). In 2018, all patients received multimodal pain therapy as standard practice, and served as the comparison group. Results A total of 10 340 patients were admitted to the trauma service from 2016 through 2018. There were 3013 and 3249 patients for review in 2016 and 2018, respectively. Total morphine milligram equivalents were 2 402 329 and 1 975 935 in 2016 and 2018, respectively, a 17.7% decrease ( P < .001). Concurrently, there was a statistically significant increase in the use of multimodal pain medications. A secondary endpoint was studied to evaluate for changes in acute kidney injury; there was not a statistically significant increase (0.56% versus 0.68%, P = .55). Discussion Implementation of an MMA guideline significantly reduced opioid use in trauma patients. The use of nonopioid MMA medications increased without an increased incidence of acute kidney injury.

Opioid Use and Chronic Infections: The Value of Addressing the Syndemic in Correctional Settings Via Telemedicine Guidance and Broader Use of Long-Acting Medications

2020 ◽  
Vol 222 (Supplement_5) ◽  
pp. S486-S493
Author(s):  
Martin Krsak ◽  
Brian T Montague ◽  
Paul Trowbridge ◽  
Steven C Johnson ◽  
Ingrid A Binswanger
Keyword(s):  
Public Health ◽  
Health Impact ◽  
The United States ◽  
Cost Of Care ◽  
Advanced Technology ◽  
Unsafe Sex ◽  
Opioid Use ◽  
Chronic Infections ◽  
Correctional Settings ◽  
Long Acting

Abstract In the United States, we are experiencing linked epidemics (a syndemic) of substance use disorders (SUDs) and infections associated with drug use, including unsafe injecting and unsafe sex in exchange for drugs or money. Current drug laws, together with risk-taking behavior among persons with SUDs, contribute to disproportionately high prevalences of these conditions in correctional settings. Detection and treatment of diseases with a high impact on public health are best addressed in the settings where such conditions are most prevalent (ie, jails and prisons for SUDs and chronic infections). The effectiveness, safety, cost of care. and public health impact of these conditions can be improved by means of broader screening and expanded access to specialty consultations through telemedicine/telehealth, along with broader use of long-acting medications for the treatment of human immunodeficiency virus and SUDs. Expanding telemedicine/telehealth, first for specialties which do not require advanced technology (eg, infectious diseases, addictions), can eventually lead to further advancements in correctional healthcare.

scholarly journals Sampling and analyses of polychlorinated dibenzo dioxins (PCDDs) and polychlorinated dibenzo furans (PCDFs) emissions in South Africa: A practitioner’s guide

2016 ◽  
Vol 24 (2) ◽  
pp. 29-32
Author(s):  
D.L. Posthumus ◽  
G.B. Woollatt
Keyword(s):  
Public Health ◽  
South Africa ◽  
Environmental Protection ◽  
Environmental Protection Agency ◽  
Health Impact ◽  
The United States ◽  
Protection Agency ◽  
Draft Report ◽  
Limit Values ◽  
The Impact

Dioxins and furans are toxic chemicals. A draft report released for public comment in September 1994 by the US Environmental Protection Agency clearly describes dioxin as a serious public health threat. The public health impact of dioxins may rival the impact that dichlorodiphenyltrichloroethane (DDT) had on public health in the 1960’s. According to the United States Environmental Protection Agency(USEPA) report, not only does there appear to be no “safe” level of exposure to dioxin, but levels of dioxin and dioxin-like chemicals have been found in the general US population that are “at or near levels associated with adverse health effects.”  With this in mind the purpose of this paper is to provide an overview of the current dioxin and furan emissions from industry in South Africa, in terms of compliance with the relevant emission limit values (ELVs) and the current challenges faced with the monitoring and analysis thereof.

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.

Opioid Overdose Education, Prevention, and Management (DRAFT)

2018 ◽  
Author(s):  
Bernd Wollschlaeger
Keyword(s):  
The United States ◽  
Opioid Use Disorder ◽  
Opioid Overdose ◽  
Opioid Use ◽  
Death Rates ◽  
Overdose Prevention ◽  
Overdose Death ◽  
Good Samaritan ◽  
Opioid Deaths ◽  
Good Samaritan Laws

In reviewing the elements of opioid overdose education, prevention, and management, this chapter focuses particularly on practical interventions that are available and deserve advocacy; e.g., provision of naloxone to those with opioid use disorder and to possible first responders. It moves from a discussion of the epidemiology of opioid deaths to the more individual topic of patient risk for overdose. Prophylactic interventions in the form of education of the patient’s family and friends, and agreements for treatment with informed consent are described. There follows a discussion of management of the opioid poisoning itself, including use/distribution of naloxone injection. Two figures are included: drug overdose death rates in the United States (2014); a map describing the current states with naloxone or “good Samaritan” laws impacting opioid overdose management. A text box with resources includes directions for initiation of community overdose prevention and intervention schemes.

scholarly journals The impact of project ECHO on physician preparedness to treat opioid use disorder: a systematic review

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Hunter M. Puckett ◽  
Jenny S. Bossaller ◽  
Lincoln R. Sheets
Keyword(s):  
Systematic Review ◽  
Health Care ◽  
Health Care Professionals ◽  
Underserved Populations ◽  
Medical Condition ◽  
The United States ◽  
Opioid Use Disorder ◽  
Opioid Use ◽  
Project Echo ◽  
The Impact

AbstractOpioid use disorder (OUD) is a medical condition that has evolved into a serious and deadly epidemic in the United States. Both medical and psychological interventions are called for to end this growing epidemic, but too few health care professionals are trained to treat OUD. One proven model of training physicians and cross-disciplinary teams in treating a variety of disorders is exemplified by Project ECHO (Extension for Community Healthcare Outcomes), a collaborative tele-mentoring program in which specialists train health-care workers to treat medical conditions, especially those that affect underserved populations. This systematic review found that Project ECHO has the potential to effectively extend current services to patients suffering from OUD, but that there is also a gap in knowledge regarding this type of training. The articles that we reviewed all presented evidence that Project ECHO improves healthcare provider preparedness to treat OUD, especially in regard to improving knowledge and self-efficacy.

scholarly journals ‘Unfreezing’ traditional teaching

2021 ◽  
Vol 3 (1) ◽  
pp. 17-18
Author(s):  
Philippa Smith ◽  
Helen Sissons
Keyword(s):  
Learning Experience ◽  
Health Impact ◽  
The United States ◽  
Virtual Classroom ◽  
Educational Systems ◽  
Face To Face ◽  
The Government ◽  
Sudden Transition ◽  
University Lecturers ◽  
The Impact

Teaching online is not an unfamiliar phenomenon for university lecturers evidenced by the rapid rise in the number of those who “want to teach online”, “have been told to teach online” and “are training and encouraging others to teach online” (Ko & Rossen, 2017:xx). Never-the-less, the impact of the Coronavirus pandemic in 2020 caught many teachers from elementary to tertiary level unprepared and in some cases led to the collapse of educational systems in countries around the world (Mishra, Gupta & Shree, 2020).   Moving lessons online, creating virtual classrooms, accessing appropriate software and online tools, as well as being competent in the use of them within a very short time period not only required “adjustment” but also had a “mental health impact” on both the educators and the students (Etchells et al, 2020). Attempts have been made to assess the success with which lecturers have been able to transition their classes to online. A survey of students in the United States (USC Center for the Digital Future, 2020), for example, asked about their remote learning experience during the pandemic and found that only around one-third enjoyed it better than in-class instruction. In addition, almost one half of them felt they learned less online than in person, and only around half of the students believed that their teachers were good at adapting their courses for online construction. This raises the question of whether educational institutions and their staff were up to speed enough with online learning to make this sudden transition.   For those running practical teaching programmes that require face-to-face contact, the thrust into the isolation of Covid-19 lock-down was most challenging. This presentation documents our learning experiences as two Auckland University of Technology lecturers whose respective programmes involving journalism practice and student collaborative movie-making were caught midway by lockdown when the government commanded us to “Stay Home, Save Lives”. Viewing our teaching experiences through the lens of change management theory (Lewin, 1958) that divides the process of change into the three stages of unfreezing – changing– refreezing, we discuss how the unfreezing of our standard methods of instruction forced us into change where we had no other choice but to learn to adapt our courses and teach online. We provide insights in this presentation as to how well the new methods of the virtual classroom worked for us based on the resources we were given, and whether they are now refrozen and maintained in our classes for the future, or will we simply change back to our original methods. We also offer feedback from the students and their experiences of our lessons in lockdown.    

A scoping review of acupuncture insurance coverage in the United States

2020 ◽  
pp. 096452842096421
Author(s):  
Roselle Bleck ◽  
Emma Marquez ◽  
Melanie A Gold ◽  
Carolyn L Westhoff
Keyword(s):  
United States ◽  
Scoping Review ◽  
Insurance Coverage ◽  
Research Priorities ◽  
The United States ◽  
Subject Area ◽  
Published Data ◽  
Opioid Use ◽  
Knowledge Gaps ◽  
The Impact

Background: Increasing access to non-pharmacologic pain management modalities, including acupuncture, has the potential to reduce opioid overuse. A lack of insurance coverage for acupuncture could present a barrier for both patients and providers. The objective of this scoping review was to assess the existing literature on acupuncture insurance coverage in the United States and to identify knowledge gaps and research priorities. Methods: We utilized the Arksey and O’Malley framework to guide our scoping review methodology. We followed a pre-determined study protocol for the level-one abstract and level-two full text screenings. We synthesized information into subject-area domains and identified knowledge gaps. Results: We found a lack of published data on acupuncture coverage in 44 states, especially in the Midwest and the South. Where data were available, a large proportion of acupuncture users did not have insurance coverage. Consumer demand, state mandates, and efforts to reduce opioid use were motivations to cover acupuncture. Licensed acupuncturists were less likely to be reimbursed and were reimbursed at lower rates compared to physicians. Reported barriers encountered when implementing coverage included a lack of providers, challenges determining when to offer non-pharmacologic treatments, and a lack of evidence for clinical efficacy and cost-effectiveness. Conclusion: We found a lack of recent publications and data comparing regional coverage in the United States. A key challenge is that commercial insurance plan data are not in the public domain. Further research should assess insurance coverage implementation for acupuncture and measure the impact of policy changes on acupuncture utilization and rates of opioid overuse.

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