Prevalence and correlates of non-fatal overdose among people who use drugs: findings from rapid assessments in Massachusetts, 2017–2019

Shrestha, Shikhar; Stopka, Thomas J.; Hughto, Jaclyn M. White; Case, Patricia; Palacios, Wilson R.; Reilly, Brittni; Green, Traci C.

doi:10.1186/s12954-021-00538-9

Cited by 19 publications

(11 citation statements)

References 66 publications

(88 reference statements)

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“…Individuals who dropped out of the program had overdosed in the past more than those who were retained, suggesting that individuals with an extensive history of substance use may need additional support maintaining engagement in an outpatient program. A recent study found individuals who experienced a non-fatal overdose were at increased risk of successive overdose and were more likely to engage in polysubstance use [ 20 , 21 ]. Moreover, polysubstance use may contribute to lifetime prevalence of overdose.…”

Section: Discussionmentioning

confidence: 99%

Machine Learning for Predicting Risk of Early Dropout in a Recovery Program for Opioid Use Disorder

et al. 2022

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Background: An increase in opioid use has led to an opioid crisis during the last decade, leading to declarations of a public health emergency. In response to this call, the Houston Emergency Opioid Engagement System (HEROES) was established and created an emergency access pathway into long-term recovery for individuals with an opioid use disorder. A major contributor to the success of the program is retention of the enrolled individuals in the program. Methods: We have identified an increase in dropout from the program after 90 and 120 days. Based on more than 700 program participants, we developed a machine learning approach to predict the individualized risk for dropping out of the program. Results: Our model achieved sensitivity of 0.81 and specificity of 0.65 for dropout at 90 days and improved the performance to sensitivity of 0.86 and specificity of 0.66 for 120 days. Additionally, we identified individual risk factors for dropout, including previous overdose and relapse and improvement in reported quality of life. Conclusions: Our informatics approach provides insight into an area where programs may allocate additional resources in order to retain high-risk individuals and increase the chances of success in recovery.

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Section: Discussionmentioning

confidence: 99%

Machine Learning for Predicting Risk of Early Dropout in a Recovery Program for Opioid Use Disorder

et al. 2022

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“…In the last few decades, RA methods have mostly been applied in low-income countries and humanitarian settings involving displaced communities [ 31 – 33 ]. In the last decade, a few studies deployed the methodology likewise in high-income settings [ 34 , 35 ]. These methods have been proven to gather knowledge about sensitive topics, such as substance use or HIV, whose affected populations might be difficult to involve in research [ 36 , 37 ].…”

Section: Methodsmentioning

confidence: 99%

Substance (mis)use among refugees as a matter of social ecology: insights into a multi-site rapid assessment in Germany

et al. 2023

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Background Previous research concluded that substance (mis)use is increasing among forcibly displaced populations. Nevertheless, little research has been conducted within a social ecological framework aimed at identifying and understanding the factors affecting substance (mis)use embedded in the post-migration context in high-income countries. The present study aims to develop an understanding of the links and underlying mechanisms between refugees’ social ecological determinants and substance (mis)using behavior. Methods Rapid assessments (RAs), including 108 semi-structured interviews and 10 focus group discussions with key persons from various professional, and personal backgrounds, were carried out in German urban and rural areas. The RA approach of interviewing key persons and not solely refugees that (mis)use substances allowed us to gather multi-perspective knowledge on this sensitive topic. Qualitative content analysis was applied, aiming at identifying determinants of substance (mis)use embedded in the post-migration context of refugees and understanding the underlying mechanisms. Results One main result of the data suggests that the link between refugees’ countries of origin and their post-migration substance (mis)use is not as direct as often assumed. It is observed that refugees’ prospects and opportunities in receiving countries (e.g., work permits) undermine this commonly reproduced link. Further determinants are related to living conditions in German refugee shelters and social relations with peers and families. The influence of refugees’ living conditions can be summarized as potentially increasing substance availability and distress, whereas family separation produces a loss of control and responsibility, increasing the risk for substance (mis)use. Peers’ influence on substance (mis)use was reported to reflect a search for a sense of belonging. Conclusions Given that refugees who (mis)use substances have limited to no control over the factors identified in our study to be associated with substance (mis)use, common treatment and prevention approaches are challenged. Furthermore, we recommend aiming for a holistic comprehension of refugees’ substance (mis)use by expanding the focus beyond individuals to the social ecological context in any attempt, including prevention, treatment, research, and policy.

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“…We classi ed population size as urban (> 50,000), metro (< 50,000 but within large metro area), and non-metro/rural (less than 25,000 and not within large metro area). Finally, we classi ed overdose rates (de ned as fatal opioid overdoses per 100,000 population in 2021) as very high (50-69), high (40-49), average (30-39) or lower (11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29) relative to all participating sites. While monthly monitoring to obtain indicator data occurred at all sites, more in-depth evaluation involving semi-structured interviews, eld observations, and site visits occurred only at 12 selected sites.…”

Section: Evaluation Designmentioning

confidence: 99%

“…8, 9 The purity of substances and amount of fentanyl contaminants are unpredictable, thus contributing to fentanyl's prominent role in drug-related morbidity and mortality. [10][11][12] These factors combined have led to a dangerously high risk of overdose among people who use drugs (PWUDs); in a rapid assessment conducted between 2017 and 2019 with 469 PWUDs in the state of Massachusetts, 36.9% reported a past-year nonfatal overdose event 13 .…”

Section: Introductionmentioning

confidence: 99%

Police-led Fentanyl Test Strip Distribution Program in Maine and Massachusetts: An Evaluation

Larson

Silcox

Olson

et al. 2022

Preprint

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Background: The increase of illicitly manufactured fentanyl in the drug supply and the lack of a reliable fentanyl detection method have led to a public health innovation: the community distribution and use of fentanyl test strips (FTS) to detect presence of fentanyl in drugs. The One2One project, based on a 2020 six-site pilot project, was a police-driven project spearheaded in Massachusetts and Maine in 2021 that consisted of police and community collaborators using FTS distribution as a low barrier tool to engage with people who use drugs and connect them to harm reduction supplies, services and referrals. Methods: Implementation and evaluation of the program occurred over 8-months. Policeofficers and program staff were trained on community use of FTS and were provided technical and logistical supports to encourage broad-scale local distribution of FTS kits to people who use drugs. The structure of the program encouraged departments to be innovative around FTS distribution and to use test strips as tools to support PWUDs with referrals, direct services and other harm reduction resources. The evaluation included site observations, interviews of staff and recipients, a community stakeholder survey, and analysis of administrative and demographic data to measure uptake and reach (engagement ratio and kit distribution impact rate) of the project as well as catalog implementation successes and challenges across participating police departments.Results: Twenty-one police departments and their collaborators distributed 2,556 FTS kits and reported a combined 3,703 referrals or direct services, yielding an engagement ratio of 1.44 (one referral or service per FTS kit distributed) and a kit distribution impact rate (kits distributed per overdose mortality rate) of 4.37 conveying substantial public health reach of FTS in high overdose burden communities. Qualitative data analysis captured the nuances across police departments of FTS kit distribution approaches, engagement methodologies, and the shift in willingness to embrace harm reduction principles through police-led efforts. Conclusion: FTS distribution through the One2One program exemplifies new and evolving shifts in public health and harm reduction policing roles and strategies. Further research should investigate how FTS distribution can be integrated across more geographies and implemented by other institutions.

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Prevalence and correlates of non-fatal overdose among people who use drugs: findings from rapid assessments in Massachusetts, 2017–2019

Cited by 19 publications

References 66 publications

Machine Learning for Predicting Risk of Early Dropout in a Recovery Program for Opioid Use Disorder

Machine Learning for Predicting Risk of Early Dropout in a Recovery Program for Opioid Use Disorder

Substance (mis)use among refugees as a matter of social ecology: insights into a multi-site rapid assessment in Germany

Police-led Fentanyl Test Strip Distribution Program in Maine and Massachusetts: An Evaluation

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