Covid-19-related changes to drug-selling networks and their effects on people who use illicit opioids

Frank, David; Krawczyk, Noa; Arshonsky, Joshua; Bragg, Marie A.; Friedman, Sam R.; Bunting, Amanda M.

doi:10.15288/jsad.21-00438

Cited by 7 publications

(5 citation statements)

References 33 publications

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“…Among people who use opioids in the United States, one study found a greater fraction decreased their use than increased it ( 44 ), while a study of people with OUD in Canada found 47% were using more drugs than usual, 44% were using a wider variety of drugs (a finding echoed in another Canadian study showing destabilization in the local drug market ( 45 )), and 39% were more often using alone ( 46 ). A small US study also found increases in use while alone ( 12 ), and a recent analysis of Reddit users found disruptions to supply, especially among pill users ( 47 ).…”

Section: Discussionmentioning

confidence: 98%

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Enumerating contributions of fentanyls and other factors to the unprecedented 2020 rise in opioid overdose deaths: model-based analysis

et al. 2023

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In 2020, the ongoing U.S. opioid overdose crisis collided with the emerging COVID-19 pandemic. Opioid overdose deaths (OODs) rose an unprecedented 38%, due to a combination of COVID-19 disrupting services essential to people who use drugs, continued increases in fentanyls in the illicit drug supply, and other factors. How much did these factors contribute to increased OODs? We used a validated simulation model of the opioid overdose crisis, SOURCE, to estimate excess OODs in 2020 and the distribution of that excess attributable to various factors. Factors affecting OODs that could have been disrupted by COVID-19, and for which data were available, included opioid prescribing, naloxone distribution, and receipt of medications for opioid use disorder. We also accounted for fentanyls’ presence in the heroin supply. We estimated a total of 18,276 potential excess OODs, including 1,792 lives saved due to increases in buprenorphine receipt and naloxone distribution and decreases in opioid prescribing. Critically, growth in fentanyls drove 43% (7,879) of the excess OODs. A further 8% is attributable to first-ever declines in methadone maintenance treatment and extended-released injectable naltrexone treatment, most likely due to COVID-19-related disruptions. In all, 49% of potential excess OODs remain unexplained, at least some of which are likely due to additional COVID-19-related disruptions. While the confluence of various COVID-19-related factors could have been responsible for more than half of excess OODs, fentanyls continued to play a singular role in excess OODs, highlighting the urgency of mitigating their effects on overdoses.

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Section: Discussionmentioning

confidence: 98%

“…Sixth, counterfeit pills are increasingly being made with illicit fentanyls ( 48 ), and there is some suggestion the pandemic accelerated this trend ( 47 ). However, we know of no national-level data that would allow us to estimate who the primary users of counterfeit pills are (i.e.…”

Section: Discussionmentioning

confidence: 99%

Enumerating contributions of fentanyls and other factors to the unprecedented 2020 rise in opioid overdose deaths: model-based analysis

et al. 2023

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“…However, when assessing trends, their year-over-year analysis did not control for the step increase in mortality level that occurred in the early spring of 2020. The authors assumed that the step increase could be attributed to the change in methadone regulations, yet the increase in level also has been found in drug overdose deaths that did not involve methadone 8 , 33 , 34 , 35 and in related domains, such as alcohol use disorder–associated deaths. 36 , 37 , 38 Disruptions related to COVID-19 provide a more intuitive and parsimonious explanation for the step increases.…”

Section: Discussionmentioning

confidence: 99%

Racial, Ethnic, and Sex Differences in Methadone-Involved Overdose Deaths Before and After the US Federal Policy Change Expanding Take-home Methadone Doses

et al. 2023

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ImportanceIn March 2020, the Substance Abuse and Mental Health Services Administration (SAMHSA) permitted states to relax restrictions on take-home methadone doses for treatment-adherent patients to minimize COVID-19 exposures.ObjectiveTo assess whether the methadone take-home policy change was associated with drug overdose deaths among different racial, ethnic, and sex groups.Design, Setting, and ParticipantsInterrupted time series analysis from January 1, 2018, to June 30, 2022. Data analysis was conducted from February 18, 2023, to February 28, 2023. In this population-based cohort study of drug overdose mortality including 14 529 methadone-involved deaths, monthly counts of methadone-involved drug overdose deaths were obtained for 6 demographic groups: Hispanic men and women, non-Hispanic Black men and women, and non-Hispanic White men and women.ExposureOn March 16, 2020, in response to the first wave of the COVID-19 pandemic, SAMHSA issued an exemption to the states that permitted up to 28 days of take-home methadone for stable patients and 14 days for less stable patients.Main Outcome MeasuresMonthly methadone-involved overdose deaths.ResultsFrom January 1, 2018, to June 30, 2022 (54 months), there were 14 529 methadone-involved deaths in the United States; 14 112 (97.1%) occurred in the study’s 6 demographic groups (Black men, 1234; Black women, 754; Hispanic men, 1061; Hispanic women, 520; White men, 5991; and White women, 4552). Among Black men, there was a decrease in monthly methadone deaths associated with the March 2020 policy change (change of slope from the preintervention period, −0.55 [95% CI, −0.95 to −0.15]). Hispanic men also experienced a decrease in monthly methadone deaths associated with the policy change (−0.42 [95% CI, −0.68 to −0.17]). Among Black women, Hispanic women, White men, and White women, the policy change was not associated with a change in monthly methadone deaths (Black women, −0.27 [95% CI, −1.13 to 0.59]; Hispanic women, 0.29 [95% CI, −0.46 to 1.04]; White men, –0.08 [95% CI, −1.05 to 0.88]; and White women, −0.43 [95% CI, −1.26 to 0.40]).Conclusions and RelevanceIn this interrupted time series study of monthly methadone-involved overdose deaths, the take-home policy may have helped reduce deaths for Black and Hispanic men but had no association with deaths of Black or Hispanic women or White men or women.

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“…Many research groups have also created models to automatically identify posts on X and Reddit with discussion related to opioids. (42,43,109,(124)(125)(126)(127) Others have used these platforms to characterize factors that influence opioid use, recovery, and the opioid epidemic generally (6,8,(128)(129)(130)(131)(132), with particular interest shown to the impact of the COVID-19 pandemic (103,120,(133)(134)(135)(136)(137)(138)(139) and co-use between opioids and other drugs (140,141).…”

Section: Prior Use In Research Literaturementioning

confidence: 99%

Which Social Media Platforms Provide the Most Informative Data for Monitoring the Opioid Crisis?

Carpenter,

Nguyen,

Smith

et al. 2024

Preprint

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Background and AimsSocial media can provide real-time insight into trends in substance use, addiction, and recovery. Prior studies have leveraged data from platforms such as Reddit and X (formerly Twitter), but evolving policies around data access have threatened their usability in opioid overdose surveillance systems. Here, we evaluate the potential of a broad set of platforms to detect emerging trends in the opioid crisis.DesignWe identified 72 online platforms with a substantial global user base or prior citations in opioid-related research. We evaluated each platform’s fit with our definition of social media, size of North American user base, and volume of opioid-related discourse. We created a shortlist of 11 platforms that met our criteria. We documented basic characteristics, volume and nature of opioid discussion, official policies regulating drug-related discussion, and data accessibility of shortlisted platforms.SettingUSA and Canada.MeasurementsWe quantified the volume of opioid discussion by number of platform-specific Google search hits for opioid terms. We captured informal language by including slang generated using a large language model. We report the number of opioid-related hits and proportion of opioid-related hits to hits for common nouns.FindingsWe found that TikTok, YouTube, and Facebook have the most potential for use in opioid-related surveillance. TikTok and Facebook have the highest relative amount of drug-related discussions. Language on TikTok was predominantly informal. Many platforms offer data access tools for research, but changing company policies and user norms create instability. The demographics of users varies substantially across platforms.ConclusionsSocial media data sources hold promise for detecting trends in opioid use, but researchers must consider the utility, accessibility, and stability of data on each platform. A strategy mixing several platforms may be required to cover all demographics suffering in the epidemic.

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Covid-19-related changes to drug-selling networks and their effects on people who use illicit opioids

Cited by 7 publications

References 33 publications

Enumerating contributions of fentanyls and other factors to the unprecedented 2020 rise in opioid overdose deaths: model-based analysis

Enumerating contributions of fentanyls and other factors to the unprecedented 2020 rise in opioid overdose deaths: model-based analysis

Racial, Ethnic, and Sex Differences in Methadone-Involved Overdose Deaths Before and After the US Federal Policy Change Expanding Take-home Methadone Doses

Which Social Media Platforms Provide the Most Informative Data for Monitoring the Opioid Crisis?

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