Trends in comorbid opioid and stimulant use disorders among Veterans receiving care from the Veterans Health Administration, 2005–2019

Warfield, Sara; Bharat, Chrianna; Bossarte, Robert M.; DePhilippis, Dominick; Farrell, Michael; Hoover, Martin E.; Larney, Sarah; Marshalek, Patrick; McKetin, Rebecca; Degenhardt, Louisa

doi:10.1016/j.drugalcdep.2022.109310

Cited by 14 publications

(8 citation statements)

References 23 publications

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“…This shifted to prescription opioids during 2007-2013 (known as the 'first wave' of the overdose crisis), heroin 2014-2014 ("second wave") and illicit fentanyl analogues 2016-present ("third wave"). Recently, scholars have argued that the 'fourth wave' of the US overdose crisis has begun, in recognition of rapidly rising polysubstance overdose deaths involving illicitly manufactured fentanyls, with stimulants playing a key role [2][3][4] . A wide range of polysubstance formulations have been noted in drug checking and overdose mortality data, with myriad substances implicated across numerous drug classes [5][6][7] .…”

Section: Introductionmentioning

confidence: 99%

Charting the Fourth Wave: Geographic, Temporal, Race/Ethnicity, and Demographic Trends in Polysubstance Fentanyl Overdose Deaths in the United States, 2010-2021

Friedman

Shover

2022

Preprint

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Aims: To characterize polysubstance death in the United States during the transition to the fourth wave of the overdose crisis. To characterize co-involved substances in fatal overdose involving synthetic opioids (mainly illicitly manufactured fentanyl analogs) by year, state, and intersectional sociodemographic groups. Design: Population-based cohort study of national death records. Setting: United States. Participants/Cases: People who died from drug overdose in the United States between 2010-2021. Measurements: Percentage of all fatal overdose involving fentanyls, stimulants, and other drugs. Most commonly co-involved substances in fentanyl overdose by state and year. Percentage of fatal fentanyl overdose co-involving stimulants by state and year. Percentage of fatal fentanyl overdose co-involving stimulants by intersectional region, race/ethnicity, age, and sex. Findings: The percent of US overdose deaths involving both fentanyl and stimulants concurrently rose nearly 60-fold, from 0.6% (n=235) in 2010 to 32.3% (n=34,424) in 2021. In 2010, fentanyl was most commonly found alongside prescription opioids, benzodiazepines, and alcohol. In the Northeast this shifted to heroin-fentanyl co-involvement in the mid-2010s, and nearly universally to cocaine-fentanyl co-involvement by 2021. Universally in the West, and in the majority of states in the South and Midwest, methamphetamine-fentanyl co-involvement predominated by 2021. The proportion of stimulant involvement in fentanyl-involved overdose deaths rose in virtually every state 2015-2021. Cluster analysis reveals particularly high rates for older Black and African American individuals living in the West. Conclusions: By 2021 stimulants were the most common drug class found in fentanyl-involved overdoses in every state in the US. The rise of deaths involving cocaine and methamphetamine must be understood in the context of a drug market dominated by illicit fentanyls, which have made polysubstance use more desirable and commonplace. The widespread concurrent use of fentanyl and stimulants, as well as other polysubstance formulations, presents novel health risks and public health challenges. Ongoing nuanced surveillance is needed to track this rapidly shifting phenomenon.

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Section: Introductionmentioning

confidence: 99%

Charting the Fourth Wave: Geographic, Temporal, Race/Ethnicity, and Demographic Trends in Polysubstance Fentanyl Overdose Deaths in the United States, 2010-2021

Friedman

Shover

2022

Preprint

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“…Strategies for adoption within FQHCs and other outpatient settings include the Centers for Medicare and Medicaid Services adding CM as a federal Medicaid benefit, 2 and the US Department of Health and Human Services Office of Inspector General clarifying that CM payments can be implemented without violating Civil Monetary Penalties Law or the Anti-Kickback Statute. 8,9 In 2022, California launched a CM Medicaid coverage pilot and our results support prioritization of FQHC as adoption locations. 9 Development of an effective mobile telephone-delivered CM treatment for stimulant use disorder and MOUD could also expand availability but would be dependent on stable patient mobile telephone access.…”

Section: Discussionmentioning

confidence: 57%

“…The FQHC adoption of CM could expand availability for the treatment of stimulant use disorder while also providing opportunities to integrate CM with MOUD treatment. Strategies for adoption within FQHCs and other outpatient settings include the Centers for Medicare and Medicaid Services adding CM as a federal Medicaid benefit, 2 and the US Department of Health and Human Services Office of Inspector General clarifying that CM payments can be implemented without violating Civil Monetary Penalties Law or the Anti-Kickback Statute 8,9 . In 2022, California launched a CM Medicaid coverage pilot and our results support prioritization of FQHC as adoption locations 9 .…”

Section: Discussionmentioning

confidence: 65%

Drive Time to Addiction Treatment Facilities Providing Contingency Management across Rural and Urban Census Tracts in 6 US States

et al. 2023

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Objective: We examined drive times to outpatient substance use disorder treatment providers that provide contingency management (CM) and those that integrate CM with medication for opioid use disorder (MOUD) services in 6 US states Methods: We completed cross-sectional geospatial analysis among census tracts in Delaware, Louisiana, Massachusetts, North Carolina, New York, and West Virginia. We excluded census tracts with a population of zero. Using data from the 2020 Shatterproof substance use treatment facility survey, our outcome was the minimum drive time in minutes from the census tract mean center of population to the nearest outpatient CM provider, outpatient CM provider with MOUD services, and federally qualified health centers (FQHC). We stratified census tracts by 2010 Rural-Urban Commuting Area codes and by state. Results: The population was greater than zero in 11,719 of 11,899 census tracts. The median drive time to the nearest CM provider was 12.2 [interquartile range (IQR), 7.0-23.5) minutes and the median drive time to the nearest CM provider increased from 9.7 (IQR, 6.0-15.0) minutes in urban census tracts to 38.8 (IQR, 25.4-53.0) minutes in rural (H = 3683, P < 0.001). The median drive time increased to the nearest CM provider with MOUD services [14.2 (IQR, 7.9-29.5) minutes, W = 18,877, P < 0.001] and decreased to the nearest FQHC [7.9 (IQR,) minutes, W = 11,555,894, P < 0.001]. Conclusions: These results suggest limited availability of CM, particularly within rural communities and for patients needing concurrent CM and MOUD treatment. Our results suggest greater adoption of CM within FQHCs could reduce urban-rural disparities in CM availability.

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“…Despite the high prevalence of methamphetamine use among CLS-involved older adults in general, 3 most research on SUD interventions for CLS populations focuses on alcohol or opioid use disorders. [17][18][19][20] Meanwhile, the prevalence of co-occurring opioid and methamphetamine use disorder is increasing sharply among veterans, 21 and methamphetamine use itself is associated with multimorbidity. 22 Proper screening of older CLS-involved veterans for SUDs is critical in linking patients to treatment, including contingency management.…”

Section: Discussionmentioning

confidence: 99%

Co-occurring Medical Multimorbidity, Mental Illness, and Substance Use Disorders Among Older Criminal Legal System-Involved Veterans

et al. 2023

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Background: Older veterans involved in the criminal legal system (CLS) may have patterns of multimorbidity that place them at risk for poor health outcomes. Objectives: To estimate the prevalence of medical multimorbidity (≥2 chronic medical diseases), substance use disorders (SUDs), and mental illness among CLS-involved veterans aged 50 and older. Research Design: Using Veterans Health Administration health records, we estimated the prevalence of mental illness, SUD, medical multimorbidity, and the co-occurrence of these conditions among veterans by CLS involvement as indicated by Veterans Justice Programs encounters. Multivariable logistic regression models assessed the association between CLS involvement, the odds for each condition, and the co-occurrence of conditions. Subjects: Veterans aged 50 and older who received services at Veterans Health Administration facilities in 2019 (n=4,669,447). Methods: Mental illness, SUD, medical multimorbidity. Results: An estimated 0.5% (n=24,973) of veterans aged 50 and older had CLS involvement. For individual conditions, veterans with CLS involvement had a lower prevalence of medical multimorbidity compared with veterans without but had a higher prevalence of all mental illnesses and SUDs. After adjusting for demographic factors, CLS involvement remained associated with concurrent mental illness and SUD (adjusted odds ratio [aOR] 5.52, 95% CI=5.35–5.69), SUD and medical multimorbidity (aOR=2.09, 95% CI=2.04–2.15), mental illness and medical multimorbidity (aOR=1.04, 95% CI=1.01–1.06), and having all 3 simultaneously (aOR=2.42, 95% CI=2.35–2.49). Conclusions: Older veterans involved in the CLS are at high risk for co-occurring mental illness, SUDs, and medical multimorbidity, all of which require appropriate care and treatment. Integrated care rather than disease-specific care is imperative for this population

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Trends in comorbid opioid and stimulant use disorders among Veterans receiving care from the Veterans Health Administration, 2005–2019

Cited by 14 publications

References 23 publications

Charting the Fourth Wave: Geographic, Temporal, Race/Ethnicity, and Demographic Trends in Polysubstance Fentanyl Overdose Deaths in the United States, 2010-2021

Charting the Fourth Wave: Geographic, Temporal, Race/Ethnicity, and Demographic Trends in Polysubstance Fentanyl Overdose Deaths in the United States, 2010-2021

Drive Time to Addiction Treatment Facilities Providing Contingency Management across Rural and Urban Census Tracts in 6 US States

Co-occurring Medical Multimorbidity, Mental Illness, and Substance Use Disorders Among Older Criminal Legal System-Involved Veterans

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