A Public Health Strategy for the Opioid Crisis

Saloner, Brendan; McGinty, Emma E.; Beletsky, Leo; Bluthenthal, Ricky N.; Beyrer, Chris; Botticelli, Michael; Sherman, Susan G.

doi:10.1177/0033354918793627

Cited by 176 publications

(150 citation statements)

References 81 publications

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“…The result was an unprecedented rise in non‐medical use of prescription opioids (NMPO), which refers to the use of prescription opioids not as directed by the prescribing clinician , and related overdose deaths . Use of PO and NMPO, and subsequent efforts to curb their supply , also increased likelihood of transitioning to heroin use and successive adoption of higher risk practices, such as injection . This trend occurred amid changes to the illicit drug supply resulting in increased availability of pure, low‐cost heroin and emergence of highly potent IMFA and analogues to street drug markets.…”

Section: Introductionmentioning

confidence: 99%

Trends in opioid initiation among people who use opioids in three US cities

Rouhani

Park

Morales

et al. 2020

Drug and Alcohol Review

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Introduction and Aims. The increased availability of prescription opioids (PO) and non-medical prescription opioids (NMPO) has fundamentally altered drug markets and typical trajectories from initiation to high-risk use among people who use opioids (PWUO). This multi-site study explores trends in opioid initiation in three US cities and associations with sociodemographic factors, current drug use and overdose risk. Design and Methods. We analysed survey data from a cross-sectional study of PWUO in Baltimore, Maryland (n = 173), Boston, Massachusetts (n = 80) and Providence, Rhode Island (n = 75). Age of first exposure to PO, NMPO and heroin was used to calculate opioid of initiation, and multinomial regression was employed to explore correlates of initiating with each. Results. Thirty-three percent of PWUO initiated with heroin, 24% with PO, 18% with NMPO and 24% with multiple opioids in their first year of use. We observed a reduction in heroin initiation and gradual replacement with PO/NMPO over time. Women were more likely to initiate with NMPO [relative risk ratio (RRR) 2.4; 95% confidence interval (CI) 1.1, 5.0], PO (RRR 2.2, 95% CI 1.1, 4.4) or multiple opioids (RRR 2.1, 95% CI 1.1, 4.2), than heroin. PWUO initiating with NMPO had significantly higher current benzodiazepine use, relative to those initiating with heroin (RRR 3.2, 95% CI 1.4, 7.4), and a high prevalence of current fentanyl use (30%). Discussion and Conclusions. Our study highlights women and PWUO initiating with NMPO as key risk groups amid the changing landscape of opioid use and overdose, and discusses implications for targeted prevention and treatment. [Rouhani S, Park JN, Morales KB, Green TC, Sherman SG. Trends in opioid initiation among people who use opioids in three US cities. Drug Alcohol Rev 2020;39: [375][376][377][378][379][380][381][382][383]

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Section: Introductionmentioning

confidence: 99%

Trends in opioid initiation among people who use opioids in three US cities

Rouhani

Park

Morales

et al. 2020

Drug and Alcohol Review

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“…The findings of this novel study underscore the complexity of the underlying forces that have precipitated the rise in deaths of despair and the larger mortality crisis within which these deaths are embedded . The results raise a number of questions that should be prioritized in future work.…”

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confidence: 81%

“…The results also highlight the need for proactive approaches to the drug overdose crisis that go beyond efforts to restrict drug supply . The stigma attached to opioid use and opioid use disorder remains a key barrier to implementing structural changes that will improve screening and treatment, particularly in vulnerable populations .…”

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confidence: 99%

Housing, housing policy, and deaths of despair

Venkataramani

Tsai

2020

Health Services Research

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The United States is in the midst of a multifaceted public health crisis, marked by increasing midlife mortality rates among nearly all racial and ethnic groups. 1-3 The burden of this crisis has fallen most heavily among vulnerable populations, particularly individuals with lower levels of income and education. 2-7 Patterns of rising mortality-which vary across time, space, and causes of death-suggest a complex set of underlying causes, many of which may have been operative for decades. 2 Since the mid-1990s, rising midlife mortality rates have been driven in large part by deaths from drug overdose-predominantly prescription, illicit, and synthetic opioid overdose-and, to a lesser extent, deaths from suicide and alcohol-related liver disease. 2,5 Research on opioid overdose deaths has largely focused on the role of increased availability of prescription opioids. 8-10 Case and Deaton recently spurred a second complementary line of inquiry, hypothesizing that elevated rates of opioid overdose, suicide, and alcohol-related mortality-collectively referred to as "deaths of despair"-have resulted from compounding social and economic disadvantage over the life course. 5,11 Investigations of this hypothesis have focused on eroding economic conditions, such as sustained declines in employment owing to foreign trade competition or manufacturing plant closures. 12-15 This literature has convincingly demonstrated the importance of these economic factors in partially explaining the observed increases in mortality at midlife. However, other potential causes warrant study. The American midlife mortality crisis may trace back to the early 1980s, which is when growth in life expectancy in the United States slowed relative to other industrialized nations, anticipating Statement: Atheendar Venkataramani and Alexander Tsai acknowledge funding from the Robert Wood Johnson Foundation, Evidence for Action (R4A) programme. They have no other disclosures to declare.

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“…The opioid epidemic has led to 47,600 overdose deaths in 2017 alone, 3,4 and an estimated 23,000 people die annually due to infections from drug‐resistant bacteria 2 . Overprescribing, or the unnecessary prescribing of medication, has been attributed to changing prescribing patterns over time, in part due to changes in guidelines 5 . Since 3 out of 4 drugs prescribed by dentists are either antibiotics or opioid analgesics, 1 dentists’ prescription writing for these agents is bound to have important public health ramifications.…”

Section: Introductionmentioning

confidence: 99%

Prescribing patterns in a US dental school from 2010 to 2017

Ticku

Starr

Silva

et al. 2020

Journal of Dental Education

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Objective: Dental education has an essential role in helping combat the opioid and antibiotic resistance crises. This study evaluates the prescribing practices of clinical instructors, advanced graduate residents, and predoctoral students in an academic dental setting. Methods: A retrospective chart review was conducted of electronic dental records from the years 2010 to 2017. The proportions of prescriptions for each drug group was calculated by prescribers' training level and specialty. Descriptive statistics were calculated for the daily opioid Morphine Milligram Equivalent (MME) dose prescribed across years and provider characteristics. Results: Over the 8 years, 65,160 prescriptions were written for 10,374 patients by 625 prescribers. The most commonly prescribed drugs were for fluoride-based medications (30%) and antibiotics (24%). Periodontists had the greatest absolute number of opioid analgesics prescriptions (n = 2712); oral maxillofacial surgeons (OMFS) prescribed more opioids than other classes of drug (49%) as a proportion of within-specialty prescriptions. Antibiotics were the most common drugs prescribed by endodontists (46%) and second most common drugs prescribed by periodontists (25%), OMFS (28%), and prosthodontists (21%). From 2010 to 2017, the proportion of prescriptions for antibiotics remained unchanged, while that of fluoride-based drugs increased from 2010 to 2014 and plateaued thereafter. The proportion of prescriptions for opioid analgesics decreased from 18% to 7%. The median daily MME dose across year and provider characteristics stayed constant (<50 MME). Conclusion: These results demonstrate encouraging prescription trends for opioid and fluoride-based drugs. Due to the high prevalence of antibiotic prescriptions in academic dental settings, stewardship approaches should be emphasized. K E Y W O R D Sanalgesics, dental health services research, opioid, pharmacology 660

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A Public Health Strategy for the Opioid Crisis

Cited by 176 publications

References 81 publications

Trends in opioid initiation among people who use opioids in three US cities

Trends in opioid initiation among people who use opioids in three US cities

Housing, housing policy, and deaths of despair

Prescribing patterns in a US dental school from 2010 to 2017

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