overdose mortality
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2022 ◽  
Author(s):  
Manuel Cano ◽  
Camila Gelpi-Acosta

This study examined differences across Latine heritage groups (i.e., Mexican, Puerto Rican, Cuban, Dominican, Central American, South American) in rates of US drug overdose mortality. The study utilized 2015-2019 mortality data from the National Center for Health Statistics for 29,137 Hispanic individuals who died of drug overdose. Using population estimates from the American Community Survey, age-standardized drug overdose mortality rates were calculated by specific Latine heritage and sex, nativity, educational attainment, and geographic region. Standardized rate ratios (SRRs), incidence rate ratios (IRRs) from negative binomial regression models, and 95% Confidence Intervals (CIs) were calculated, and multiple imputation was used for missing Latine heritage group in select models. Drug overdose mortality rates in the Puerto Rican heritage population were more than three times as high as in the Mexican heritage population (IRR 3.61 [95% CI 3.02-4.30] in unadjusted model; IRR 3.70 [95% CI 3.31-4.15] in model adjusting for age, sex, nativity, educational attainment, and region; SRR 3.23 [95% CI, 3.15-3.32] in age-standardized model with missing Hispanic heritage imputed). Higher age-standardized rates of drug overdose mortality were observed in males than females across all Latine groups, yet the magnitude of the sex differential varied by Latine heritage. The relationship between drug overdose mortality and nativity differed by Latine heritage; in all groups except Puerto Rican, overdose mortality rates were significantly higher in the US-born than those not US-born. In contrast, overdose mortality rates were significantly lower in US-born Puerto Ricans than in Puerto Ricans who were not US-born (e.g., born in Puerto Rico; SRR, 0.84 [95% CI 0.80-0.88]). The relationship between drug overdose mortality and educational attainment (for ages 25+) also varied between Latine groups. The diverse subgroups comprising the US Latine population vary not only in rates of drug overdose mortality, but also in demographic risk factors for fatal drug overdose.


2022 ◽  
pp. 002214652110672
Author(s):  
Mike Vuolo ◽  
Laura C. Frizzell ◽  
Brian C. Kelly

Policy mechanisms shaping population health take numerous forms, from behavioral prohibitions to mandates for action to surveillance. Rising drug overdoses undermined the state’s ability to promote population-level health. Using the case of prescription drug monitoring programs (PDMPs), we contend that PDMP implementation highlights state biopower operating via mechanisms of surveillance, whereby prescribers, pharmacists, and patients perceive agency despite choices being constrained. We consider whether such surveillance mechanisms are sufficient or if prescriber/dispenser access or requirements for use are necessary for population health impact. We test whether PDMPs reduced overdose mortality while considering that surveillance may require time to reach effectiveness. PDMPs reduced opioid overdose mortality 2 years postimplementation and sustained effects, with similar effects for prescription opioids, benzodiazepines, and psychostimulants. Access or mandates for action do not reduce mortality beyond surveillance. Overall, PDMP effects on overdose mortality are likely due to self-regulation under surveillance rather than mandated action.


2022 ◽  
Vol 5 (1) ◽  
pp. e2142676
Author(s):  
Danielle R. Fine ◽  
Kirsten A. Dickins ◽  
Logan D. Adams ◽  
Denise De Las Nueces ◽  
Karen Weinstock ◽  
...  

2022 ◽  
pp. 109296
Author(s):  
Mark R. Begley ◽  
Chandru Ravindran ◽  
Talya Peltzman ◽  
Sybil W. Morley ◽  
Brady M. Stephens ◽  
...  

2021 ◽  
Author(s):  
Joseph Friedman ◽  
Helena Hansen

Drug overdose mortality rates have increased sharply during the COVID-19 pandemic. In recent years, overdose death rates were rising most rapidly among racial/ethnic minority communities. The pandemic has disproportionately affected communities of color in a wide swath of health, social, and economic outcomes. Careful attention is therefore warranted to trends in overdose mortality by race/ethnicity during COVID-19. We calculated total drug overdose death rates per 100,000 population by race/ethnicity for the 1999-2020 time period. We find that Black overdose mortality overtook that of White individuals in 2020 for the first time since 1999. Between 2019 and 2020 Black individuals had the largest percent increase in overdose mortality, of 48.8%, compared to 26.3% among White individuals. In 2020, Black overdose death rates rose to 36.8 per 100,000, representing 16.3% higher than the rate for White individuals for the same period. American Indian and Alaska Native (AI/AN) individuals experienced the highest rate of overdose mortality in 2020, of 41.4 per 100,000, representing 30.8% higher than the rate among White individuals. Our findings suggest that drug overdose mortality is increasingly becoming a racial justice issue in the United States and appears to have been exacerbated by the COVID-19 pandemic. Providing individuals with a safer supply of drugs, closing gaps in access to MOUD and harm reductions services, and ending routine incarceration of individuals with substance use disorders represent urgently needed, evidence-based strategies that can be employed to reduce rising inequalities in overdose.


2021 ◽  
Vol 97 ◽  
pp. 103294
Author(s):  
Leah Hamilton ◽  
Corey S. Davis ◽  
Nicole Kravitz-Wirtz ◽  
William Ponicki ◽  
Magdalena Cerdá

2021 ◽  
Author(s):  
Alex S. Bennett ◽  
Joy Scheidell ◽  
Jeanette M. Bowles ◽  
Maria Khan ◽  
Alexis Roth ◽  
...  

Abstract Background Despite increased availability of take-home naloxone, many people who use opioids do so in unprotected contexts, with no other person who might administer naloxone present, increasing the likelihood that an overdose will result in death. Thus, there is a social nature to being “protected” from overdose mortality, which highlights the importance of identifying background factors that promote access to protective social networks among people who use opioids. Methods We used respondent-driven sampling to recruit adults residing in New York City who reported recent (past 3-day) nonmedical opioid use (n=575). Participants completed a baseline assessment that included past 30-day measures of substance use, overdose experiences, and number of “protected” opioid use events, defined as involving naloxone and the presence of another person who could administer it, as well as measures of network characteristics and social support. We used modified Poisson regression with robust variance to estimate unadjusted and adjusted prevalence ratios (PRs) and 95% confidence intervals (CIs). Results 66% of participants had ever been trained to administer naloxone, 18% had used it in the past three months, and 32% had experienced a recent overdose (past 30 days). During recent opioid use events, 64% reported never having naloxone and a person to administer present. This was more common among those: aged ≥50 years (PR: 1.18 (CI: 1.03, 1.34); who identified as non-Hispanic Black (PR: 1.27 (CI: 1.05, 1.53); experienced higher levels of stigma consciousness (PR: 1.13 (CI: 1.00, 1.28); and with small social networks (<5 persons) (APR: 1.14 (CI: 0.98, 1.31). Having a recent overdose experience was associated with severe opioid use disorder (PR: 2.45 (CI: 1.49, 4.04), suicidality (PR: 1.72 (CI: 1.19, 2.49), depression (PR: 1.54 (CI: 1.20, 1.98) and positive urinalysis result for benzodiazepines (PR: 1.56 (CI: 1.23, 1.96), but not with network size. Conclusions Results show considerable gaps in naloxone protection among people who use opioids, with more vulnerable and historically disadvantaged subpopulations less likely to be protected. Larger social networks of people who use opioids may be an important resource to curtail overdose mortality, but more effort is needed to harness the protective aspects of social networks.


2021 ◽  
pp. 106845
Author(s):  
Joseph Friedman ◽  
Helena Hansen ◽  
Ricky N. Bluthenthal ◽  
Nina Harawa ◽  
Ayana Jordan ◽  
...  

2021 ◽  
Author(s):  
Joseph Friedman ◽  
Fernando Montero Castillo ◽  
Phillippe Bourgois ◽  
Rafik Wahbi ◽  
Daniel Dye ◽  
...  

Background: Recent sharp exacerbations of the US overdose crisis have been linked to systemic polysubstance use and potent synthetic compounds in numerous drug classes. Xylazine is a veterinary tranquilizer, long noted in the opioid supply of Puerto Rico, and more recently Philadelphia. Yet it's national relevance and potential role in the shifting US overdose risk environment are poorly characterized. Methods: In this sequential mixed methods study, xylazine was increasingly observed by our ethnographic team over many years of intensive participant observation fieldwork in Philadelphia among drug sellers and people who inject drugs (PWID). Subsequently, we systematically searched for records describing xylazine-involved overdose mortality across the US and assessed time trends and overlap with other drugs. Results: In 10 jurisdictions--representing all 4 US Census Regions--xylazine was found to be increasingly implicated in overdose mortality, rising from 0.36% of deaths in 2015 to 6.7% in 2020. The highest xylazine prevalence in the most recent data was observed in Philadelphia, (25.8% of deaths), followed by Maryland (19.3%) and Connecticut (10.2%). Illicitly-manufactured-fentanyls were present in 98.4% of xylazine-involved-overdose-deaths--suggesting a strong ecological link--as well as cocaine (45.4%), benzodiazepines (28.4%), heroin (23.3%), and alcohol (19.7%). PWID in Philadelphia described xylazine as a sought-after adulterant that improves euphoria and lengthens the short duration of fentanyl injections, in particular. They also linked it to increased risk of soft tissue infection and overdose. Conclusions: We summarize evidence that xylazine is increasingly implicated in overdose deaths across the US and is linked to the proliferation of illicitly-manufactured-fentanyls. We document hypothesis-generating ethnographic accounts linking it to health risks for PWID. Nevertheless, many jurisdictions do not routinely test for xylazine, and it is not tracked in federal overdose statistics. Further efforts are needed to provide PWID with services that can help to minimize additional risks associated with a shifting drug supply.


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