Polysubstance Involvement in Opioid Overdose Deaths in Adolescents and Young Adults, 1999-2018

Lim, Jamie; Earlywine, Joel J.; Bagley, Sarah M.; Marshall, Brandon D. L.; Hadland, Scott E.

doi:10.1001/jamapediatrics.2020.5035

Cited by 49 publications

(43 citation statements)

References 4 publications

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“…This pattern has been reported in the US general population, although with mortality rates that were substantially lower than those in the BHCHP cohort. 5 , 16 , 22 As previously found in the Massachusetts population, most opioid-involved polysubstance deaths in the BHCHP cohort included cocaine. 24 …”

Section: Discussionmentioning

confidence: 77%

“…The predominance of opioid-involved polysubstance overdose deaths reflects a nationwide shift in drug overdose patterns. 5 , 16 , 22 Clinicians who serve people experiencing homelessness should take a broad approach to assessing for all types of drug use to appropriately tailor treatment. Although evidence-based treatment options for other drug use disorders are somewhat limited, contingency management has been found to be an effective treatment strategy for both opioid use disorder and stimulant use disorder.…”

Section: Discussionmentioning

confidence: 99%

“…We used the ICD-10 ( International Statistical Classification of Diseases and Related Health Problems, Tenth Revision ) codes for the underlying cause of death to define drug overdose deaths 13 (eTable 1 in the Supplement ). We used the multiple cause of death field ICD-10 T codes to identify the types of drugs involved in each drug overdose death 14 , 15 , 16 , 17 (eTable 1 in the Supplement ). A drug overdose death could involve more than 1 type of drug.…”

Section: Methodsmentioning

confidence: 99%

Section: Jama Network Open | Substance Use and Addictionmentioning

confidence: 99%

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Drug Overdose Mortality Among People Experiencing Homelessness, 2003 to 2018

et al. 2022

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IMPORTANCEDespite high rates of drug overdose death among people experiencing homelessness, patterns in drug overdose mortality, including the types of drugs implicated in overdose deaths, remain understudied in this population. OBJECTIVE To describe the patterns in drug overdose mortality among a large cohort of people experiencing homelessness in Boston vs the general adult population of Massachusetts and to evaluate the types of drugs implicated in overdose deaths over a continuous 16-year period of observation.

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Section: Discussionmentioning

confidence: 77%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Jama Network Open | Substance Use and Addictionmentioning

confidence: 99%

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Drug Overdose Mortality Among People Experiencing Homelessness, 2003 to 2018

et al. 2022

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“…10,11 According to the CDC, high-risk opioid use is defined as use of opioid products equivalent to ≥50 morphine milligram equivalents (MME) and/or the concurrent use of prescription opioids that are dispensed concomitantly with other controlled substances, particularly benzodiazepines that pose an increased risk of opioid overdose or other adverse events. [12][13][14][15] Prior work examining such high-risk use has focused on select clinical populations, such as individuals with human immunodeficiency virus (HIV) or those insured by Medicaid. 16,17 However, there is limited information on the prevalence of high-risk opioid use at the national and state level.…”

Section: Introductionmentioning

confidence: 99%

Prevalence and distribution of high‐risk prescription opioid use in the United States, 2011–2016

McCormick

Dadiomov

Trotzky-Sirr

et al. 2021

Pharmacoepidemiology and Drug

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Purpose: Despite the efforts of many stakeholders to reduce the risk of opioid overdose, there is limited information on the prevalence of high-risk prescription opioid use in the US.Methods: Descriptive analysis of a nationally representative 5% random sample of anonymized, longitudinal, individual-level prescription claims from IQVIA LRx between January 1, 2011 and December 31, 2016 among individuals ages 18 years or older that used a retail pharmacy. High-risk opioid use was defined as ≥50 morphine milligram equivalents per day and/or having concurrent dispensing of a benzodiazepine based on overlapping days of coverage.Results: The prevalence of high-risk opioid use among adults in the US decreased from 12.0% in 2011 to 9.4% in 2016 (p < 0.01). Declines were most pronounced among individuals ages 18-35 years (10.9%-7.0%, 36.2% decline; p < 0.01) compared to individuals age 65 years or greater (10.5%-9.8%, 6.7% decline; p < 0.01).Declines in high-risk use prevalence were observed across 49 states, with only South Dakota experiencing an increase (+13.7% relative increase). Similar to earlier years, in 2016 50.9% of all high-risk use opioid users received all their opioid prescriptions from a single prescriber, and 71.1% used a single pharmacy to fill them. Conclusion:Despite clinically significant declines in high-risk opioid use, in 2016 nearly 1 in 10 adult retail pharmacy users remained at high-risk for opioid overdose in the US. Future clinical and policy interventions should consider targeting older adults with Medicare Part-D, including those using a single pharmacy to fill their opioid prescriptions. K E Y W O R D Shigh-risk opioid use, opioid utilization trends, pharmacy dispensing data, prescription opioids, United States opioid use Key Points• Studies examining changes, both temporal and spatial, in high-risk prescription opioid use in the United States are limited. This study found that in 2016 nearly 1 in 10 adults is potentially at risk for opioid related overdose, especially older adults.The statements, findings, conclusions, views, and opinions contained and expressed herein are not necessarily those of IQVIA or any of its affiliated or subsidiary entities.

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Human Papillomavirus Vaccination and Trends in Cervical Cancer Incidence and Mortality in the US

et al. 2022

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The subsequent yearly decrease in concurrent dispensing prevalence was more than twice as large among young adults (12.83; 95% CI, prescriptions per 1000 enrollees per year) compared with adolescents (5.57; 95% CI, 2.81-8.32 prescriptions per 1000 enrollees per year). For adolescents, prevalence of concomitant benzodiazepine and opioid prescribing was 77.48 (95% CI, 63.39-91.57) prescriptions per 1000 adolescents in 2019.Discussion | The prevalence of dispensed benzodiazepines has been steadily decreasing for adolescents and young adults in a large commercially insured population since 2015 and 2013, respectively. Prevalence of concurrent benzodiazepine and opioid prescriptions has also decreased. These findings are consistent with reports showing declining use of benzodiazepines and opioids among adults. 5,6 We analyzed data from a single insurance provider, which may limit the generalizability of our findings to other patient populations, such as those covered by government insurance plans.Despite recent decreases in the prevalence of dispensed benzodiazepines, dispensing prevalence remained higher in 2019 than in 2008 in both age groups, and, in 2019, 8% of adolescents with a dispensed benzodiazepine prescription also filled an opioid prescription. Furthermore, among adolescents, only approximately one-quarter had a diagnosis corresponding with an approved indication, raising concern for frequent use of benzodiazepines for indications with limited clinical evidence of efficacy. Given the known risks associated with benzodiazepine use, additional efforts are needed to ensure judicious and evidence-based prescribing of benzodiazepines in adolescents and young adults.

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Polysubstance Involvement in Opioid Overdose Deaths in Adolescents and Young Adults, 1999-2018

Cited by 49 publications

References 4 publications

Drug Overdose Mortality Among People Experiencing Homelessness, 2003 to 2018

Drug Overdose Mortality Among People Experiencing Homelessness, 2003 to 2018

Prevalence and distribution of high‐risk prescription opioid use in the United States, 2011–2016

Human Papillomavirus Vaccination and Trends in Cervical Cancer Incidence and Mortality in the US

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