County-level predictors of US drug overdose mortality: A systematic review

Cano, Manuel; Oh, Sehun; Osborn, Preston; Olowolaju, Samson A.; Sanchez, Armando; Kim, Yeonwoo; Moreno, Alberto Cano

doi:10.1016/j.drugalcdep.2022.109714

Cited by 19 publications

(9 citation statements)

References 85 publications

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“…This was most evident with Consecutive Cold Spot communities which were overwhelmingly White and more a uent, educated, residentially stable, and healthy relative to Hot Spot communities. These ndings are consistent with reports of widening racial disparities in overdose deaths [3] and with ndings that socioeconomic hardship [18,19], housing insecurity [20], low educational attainment [21], and poor mental health [22] are associated with overdose risk.…”

Section: Characteristics Of Overdose Hot Spot Communitiessupporting

confidence: 91%

Using Precision Epidemiology to Identify Racialized Disparities in Overdose Mortality

Forati,

Ghose,

Mohebbi

et al. 2024

Preprint

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Efforts to understand and respond to the opioid crisis have focused on overdose fatalities. Overdose mortality rates (ratios of overdoses resulting in death) are rarely examined though they are important indicators of harm reduction effectiveness. Factors that vary across urban communities likely determine which community members are receiving the resources needed to reduce fatal overdose risk. Identifying communities with higher risk for overdose mortality and understanding influential factors is critical for guiding responses and saving lives. Using incident reports and mortality data from 2018-2021 we defined overdose mortality ratios across Milwaukee at the census tract level. To identify neighborhoods displaying higher mortality than predicted, we used Integrated Nested Laplace Approximation to define standardized mortality ratios (SMRs) for each tract. Geospatial and spatiotemporal analyses were used to identify emerging hotspots for high mortality risk. Overall, mortality was highest in Hispanic and lowest in White communities. Communities with unfavorable SMRs were predominantly Black or Hispanic, younger, less employed, poorer, less educated, and had higher incarceration rates and worse mental and physical health. Communities identified as hotspots for overdoses were predominantly non-White, poorer, and less employed and educated with worse mental and physical health, higher incarceration rates, and less housing stability. The findings demonstrate that overdose mortality rates vary across urban communities and are influenced by racial disparities. A framework that enables identification of challenged communities and guides community responses is needed.

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Section: Characteristics Of Overdose Hot Spot Communitiessupporting

confidence: 91%

Using Precision Epidemiology to Identify Racialized Disparities in Overdose Mortality

Forati,

Ghose,

Mohebbi

et al. 2024

Preprint

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“…At the individual level, there is little evidence to support the use of psychosocial interventions to improve health and well-being among sex workers, perhaps due to the structural factors at play [ 108 ]. Separate to this, unemployment was generally associated with higher risk than sex work and other income factors such as social welfare receipt, participation in the illicit drug trade, and lower socio-economic status, and it is important to note that the relationship between these factors and overdose may be mediated by social capital and isolation [ 59 , 62 , 109 ]. These, in turn, drive worse psychosocial outcomes, which are enabled by prevailing policies of state-imposed methods of control (social welfare) of non-conforming behaviour (non-participation in ‘normative’ modes of economic activity), and intentional criminalisation of drug use which erodes drug supply quality and increases overdose risk [ 10 ].…”

Section: Discussionmentioning

confidence: 99%

Psychosocial factors associated with overdose subsequent to Illicit Drug use: a systematic review and narrative synthesis

Byrne,

Sani,

Thain

et al. 2024

Harm Reduct J

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Background and aims Psychological and social status, and environmental context, may mediate the likelihood of experiencing overdose subsequent to illicit drug use. The aim of this systematic review was to identify and synthesise psychosocial factors associated with overdose among people who use drugs. Methods This review was registered on Prospero (CRD42021242495). Systematic record searches were undertaken in databases of peer-reviewed literature (Medline, Embase, PsycINFO, and Cinahl) and grey literature sources (Google Scholar) for work published up to and including 14 February 2023. Reference lists of selected full-text papers were searched for additional records. Studies were eligible if they included people who use drugs with a focus on relationships between psychosocial factors and overdose subsequent to illicit drug use. Results were tabulated and narratively synthesised. Results Twenty-six studies were included in the review, with 150,625 participants: of those 3,383–4072 (3%) experienced overdose. Twenty-one (81%) studies were conducted in North America and 23 (89%) reported polydrug use. Psychosocial factors associated with risk of overdose (n = 103) were identified and thematically organised into ten groups. These were: income; housing instability; incarceration; traumatic experiences; overdose risk perception and past experience; healthcare experiences; perception of own drug use and injecting skills; injecting setting; conditions with physical environment; and social network traits. Conclusions Global rates of overdose continue to increase, and many guidelines recommend psychosocial interventions for dependent drug use. The factors identified here provide useful targets for practitioners to focus on at the individual level, but many identified will require wider policy changes to affect positive change. Future research should seek to develop and trial interventions targeting factors identified, whilst advocacy for key policy reforms to reduce harm must continue.

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“…This seems particularly critical given the starkly heterogeneous patterns of overdose, and harm reduction and OUD treatment resource access that exist across local US jurisdictions. [66][67][68][69][70] Study findings should be considered with limitations. First, our model made simplifying assumptions.…”

Section: Discussionmentioning

confidence: 99%

Simulating the Simultaneous Impact of Medication for Opioid Use Disorder and Naloxone on Opioid Overdose Death in Eight New York Counties

Cerdá,

Hamilton,

Hyder

et al. 2024

Epidemiology

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Background: The United States is in the midst of an opioid overdose epidemic; 28.3 per 100,000 people died of opioid overdose in 2020. Simulation models can help understand and address this complex, dynamic, nonlinear social phenomenon. Using the HEALing Communities Study, aimed at reducing opioid overdoses, and an agent-based model, SiCLOPS (Simulation of Community-Level Overdose Prevention Strategy), we simulated increases in buprenorphine initiation and retention and naloxone distribution aimed at reducing overdose deaths by 40% in New York Counties. Methods: Our simulations covered 2020-2022. The eight counties contrasted urban or rural and high and low baseline rates of opioid use disorder treatment. The model calibrated agent characteristics for opioid use and use disorder, treatments and treatment access, and fatal and non-fatal overdose. Modeled interventions included increased buprenorphine initiation and retention, and naloxone distribution. We predicted decrease in the rate of fatal opioid overdose 1 year after intervention, given various modeled intervention scenarios. Results: Counties required unique combinations of modeled interventions to achieve 40% reduction in overdose deaths. Assuming a 200% increase in naloxone from current levels, high baseline treatment counties achieved 40% reduction in overdose deaths with a simultaneous 150% increase in buprenorphine initiation. In comparison, low baseline treatment counties required 250-300% increases in buprenorphine initiation coupled with 200-1,000% increases in naloxone, depending on the county. Conclusions: Results demonstrate the need for tailored county-level interventions to increase service utilization and reduce overdose deaths, as the modeled impact of interventions depended on the county’s experience with past and current interventions.

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County-level predictors of US drug overdose mortality: A systematic review

Cited by 19 publications

References 85 publications

Using Precision Epidemiology to Identify Racialized Disparities in Overdose Mortality

Using Precision Epidemiology to Identify Racialized Disparities in Overdose Mortality

Psychosocial factors associated with overdose subsequent to Illicit Drug use: a systematic review and narrative synthesis

Simulating the Simultaneous Impact of Medication for Opioid Use Disorder and Naloxone on Opioid Overdose Death in Eight New York Counties

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