Faculty Bibliography
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292
Features of the Energy Spectrum of Cosmic Rays above 2.5×10^{18} eV Using the Pierre Auger Observatory
We report a measurement of the energy spectrum of cosmic rays above 2.5×10^{18} eV based on 215 030 events. New results are presented: at about 1.3×10^{19} eV, the spectral index changes from 2.51±0.03(stat)±0.05(syst) to 3.05±0.05(stat)±0.10(syst), evolving to 5.1±0.3(stat)±0.1(syst) beyond 5×10^{19} eV, while no significant dependence of spectral features on the declination is seen in the accessible range. These features of the spectrum can be reproduced in models with energy-dependent mass composition. The energy density in cosmic rays above 5×10^{18} eV is [5.66±0.03(stat)±1.40(syst)]×10^{53} erg Mpc^{-3}.
PMID: 33016715
ISSN: 1079-7114
CID: 5910932
Trends in opioid-prescribing practices in children, adolescents, and young adults in the United States from 2006 to 2018 [Meeting Abstract]
Research Objective: The opioid epidemic in the United States remains a growing public health problem. Understanding opioid prescribing for children, adolescents, and young adults is essential for developing targeted interventions and policies at both national and local levels for this population. In this study, we investigate temporal trends in opioid-prescribing practices in children, adolescents, and young adults in the United States from 2006 to 2018.
Study Design: Cross-sectional analysis of opioid prescriptions from retail pharmacies. Primary outcomes included total number of opioid prescriptions, duration of prescription (overall mean, <=3 days, and >=30 days), amount prescribed in mean morphine milligram equivalents (MME) dispensed per day, and high-dose prescriptions (prescriptions for doses >90 MME/day for those >14 years). Yearly values were reported overall and stratified by age for 2006, 2012, and 2018, with relative percentage change between point estimates for 2006 and 2018. Population Studied: Opioid prescription data from January 1, 2006, to December 31, 2018, for children, adolescents, and young adults <25 years were extracted from the IQVIA XPonent database which accounts for 90% of retail outpatient prescriptions in the United States. Principal Findings: The opioid prescription rate (per 100 persons) decreased by 58.9% overall from 2006 to 2018, declining from a rate of 4.6-1.4 for children 0-5 years, 4.3-1.4 for those 6-9 years, 6.6-2.7 for those 10-14 years, 20.4-10.8 for adolescents 15-19 years, and 35.1-15.3 for young adults 20-24 years. The total MME/day was 36.5 in 2006, 34.4 in 2012, and 31.2 in 2018 (decrease of 14.7% by 2018), with decreased amounts prescribed in all ages, except those <=5 years. The total mean opioid prescription duration remained relatively stable, with duration of 6 days in 2006, 6.8 days in 2012, and 6.2 days in 2018. The number of prescriptions with duration <=3 days was unchanged, but the number of prescriptions with duration >=30 days increased by 31.8%, with the largest increases in children <15 years. High-dose prescriptions for the 15-24 years cohort decreased by >50% between 2006 and 2018.
Conclusion(s): Since 2006, total opioid prescriptions have decreased for children, adolescents, and young adults, and there has been a reduction in the prescription amount and in high-dose opioid prescriptions for adolescents and young adults. However, despite current opioid-prescribing guidelines, as well as policies that limit days' supply, opioids continue to be frequently dispensed and opioid prescriptions with duration >=30 days have increased. Implications for Policy or Practice: Continued policy efforts and the development of clinical practice guidelines for youths are necessary to ensure safe and judicious opioid prescribing for children, adolescents, and young adults. Further study, including investigating geographic patterns and patient-and prescriber-level characteristics, will help inform targeted interventions for appropriate prescribing practices in this population
Study Design: Cross-sectional analysis of opioid prescriptions from retail pharmacies. Primary outcomes included total number of opioid prescriptions, duration of prescription (overall mean, <=3 days, and >=30 days), amount prescribed in mean morphine milligram equivalents (MME) dispensed per day, and high-dose prescriptions (prescriptions for doses >90 MME/day for those >14 years). Yearly values were reported overall and stratified by age for 2006, 2012, and 2018, with relative percentage change between point estimates for 2006 and 2018. Population Studied: Opioid prescription data from January 1, 2006, to December 31, 2018, for children, adolescents, and young adults <25 years were extracted from the IQVIA XPonent database which accounts for 90% of retail outpatient prescriptions in the United States. Principal Findings: The opioid prescription rate (per 100 persons) decreased by 58.9% overall from 2006 to 2018, declining from a rate of 4.6-1.4 for children 0-5 years, 4.3-1.4 for those 6-9 years, 6.6-2.7 for those 10-14 years, 20.4-10.8 for adolescents 15-19 years, and 35.1-15.3 for young adults 20-24 years. The total MME/day was 36.5 in 2006, 34.4 in 2012, and 31.2 in 2018 (decrease of 14.7% by 2018), with decreased amounts prescribed in all ages, except those <=5 years. The total mean opioid prescription duration remained relatively stable, with duration of 6 days in 2006, 6.8 days in 2012, and 6.2 days in 2018. The number of prescriptions with duration <=3 days was unchanged, but the number of prescriptions with duration >=30 days increased by 31.8%, with the largest increases in children <15 years. High-dose prescriptions for the 15-24 years cohort decreased by >50% between 2006 and 2018.
Conclusion(s): Since 2006, total opioid prescriptions have decreased for children, adolescents, and young adults, and there has been a reduction in the prescription amount and in high-dose opioid prescriptions for adolescents and young adults. However, despite current opioid-prescribing guidelines, as well as policies that limit days' supply, opioids continue to be frequently dispensed and opioid prescriptions with duration >=30 days have increased. Implications for Policy or Practice: Continued policy efforts and the development of clinical practice guidelines for youths are necessary to ensure safe and judicious opioid prescribing for children, adolescents, and young adults. Further study, including investigating geographic patterns and patient-and prescriber-level characteristics, will help inform targeted interventions for appropriate prescribing practices in this population
EMBASE:633914768
ISSN: 1475-6773
CID: 4782822
The Opioid/Overdose Crisis as a Dialectics of Pain, Despair, and One-Sided Struggle
The opioid/overdose crisis in the United States and Canada has claimed hundreds of thousands of lives and has become a major field for research and interventions. It has embroiled pharmaceutical companies in lawsuits and possible bankruptcy filings. Effective interventions and policies toward this and future drug-related outbreaks may be improved by understanding the sociostructural roots of this outbreak. Much of the literature on roots of the opioid/overdose outbreak focuses on (1) the actions of pharmaceutical companies in inappropriately promoting the use of prescription opioids; (2) "deaths of despair" based on the deindustrialization of much of rural and urban Canada and the United States, and on the related marginalization and demoralization of those facing lifetimes of joblessness or precarious employment in poorly paid, often dangerous work; and (3) increase in occupationally-induced pain and injuries in the population. All three of these roots of the crisis-pharmaceutical misconduct and unethical marketing practices, despair based on deindustrialization and increased occupational pain-can be traced back, in part, to what has been called the "one-sided class war" that became prominent in the 1970s, became institutionalized as neo-liberalism in and since the 1980s, and may now be beginning to be challenged. We describe this one-sided class war, and how processes it sparked enabled pharmaceutical corporations in their misconduct, nurtured individualistic ideologies that fed into despair and drug use, weakened institutions that created social support in communities, and reduced barriers against injuries and other occupational pain at workplaces by reducing unionization, weakening surviving unions, and weakening the enforcement of rules about workplace safety and health. We then briefly discuss the implications of this analysis for programs and policies to mitigate or reverse the opioid/overdose outbreak.
PMCID:7676222
PMID: 33251171
ISSN: 2296-2565
CID: 4684742
Changes in opioid prescribing after implementation of mandatory registration and proactive reports within California's prescription drug monitoring program
BACKGROUND:In 2016, California updated its prescription drug monitoring program (PDMP), adding two key features: automated proactive reports to prescribers and mandatory registration for prescribers and pharmacists. The effects of these changes on prescribing patterns have not yet been examined. We aimed to evaluate the joint effect of these two PDMP features on county-level prescribing practices in California. METHODS:Using county-level quarterly data from 2012 to 2017, we estimated the absolute change associated with the implementation of these two PDMP features in seven prescribing indicators in California versus a control group comprising counties in Florida and Washington: opioid prescription rate per 1000 residents; patients' mean daily opioid dosage in milligrams of morphine equivalents[MME]; prescribers' mean daily MME prescribed; prescribers' mean number of opioid prescriptions per day; percentage of patients getting >90 MME/day; percentage of days with overlapping prescriptions for opioids and benzodiazepines; multiple opioid provider episodes per 100,000 residents. RESULTS:Proactive reports and mandatory registration were associated with a 7.7 MME decrease in patients' mean daily opioid dose (95 %CI: -11.4, -2.9); a 1.8 decrease in the percentage of patients prescribed high-dose opioids (95 %CI: -2.3, -0.9); and a 6.3 MME decrease in prescribers' mean daily dose prescribed (95 %CI: -10.0, -1.3). CONCLUSIONS:California's implementation of these two PDMP features was associated with decreases in the total quantity of opioid MMEs prescribed, and indicators of patients prescribed high-dose opioids compared to states that had PDMP's without these features. Rates of opioid prescribing and other high-risk prescribing patterns remained unchanged.
PMID: 33234299
ISSN: 1879-0046
CID: 4680562
COVID-19 and the health of people who use drugs: What is and what could be?
SARS-CoV-2, the virus that causes COVID-19, has changed the world as we know it, and continues to do so. How COVID-19 affects people who use drugs, the environments in which they live, and capacities of response, warrants immediate attention. This special issue begins to map how COVID-19 is altering the health of people who use drugs, including in relation to patterns of drug use, service responses, harms that may relate to drug use, interventions to reduce risk of harms, COVID-19 health, and drug policies. We emphasise the need to envisage COVID-19 and its effects as a matter of intersecting 'complex adaptive systems': that is, the impacts of COVID-19 extend beyond the virus and related illness conditions to encompass multiple social, cultural, economic, policy and political effects; and these affect the health of people who use drugs directly as well as indirectly by altering the risk and enabling environments in which they live. We synthesize emergent evidence on the impact of COVID-19 on the health of people who use drugs. A key concern we identify is how to sustain policy and service delivery improvements prompted by COVID-19. We need to maintain an ethos of emergent adaptation and experimentation towards the creation of safer environments in relation to the health of people who use drugs.
PMID: 33183679
ISSN: 1873-4758
CID: 4679912
Pregnancy and Access to Treatment for Opioid Use Disorder
PMID: 32797172
ISSN: 2574-3805
CID: 4566232
Suicidal ideation and attempts following nonmedical use of prescription opioids and related disorder
BACKGROUND:Since 1999, the rate of fatal prescription opioid overdoses and of suicides has dramatically increased in the USA. These increases, which have occurred among similar demographic groups, have led to the hypothesis that the opioid epidemic contributed to increases in suicidal behavior, though the underlying association remains poorly defined. We examine the association between nonmedical use of prescription opioids/opioid use disorder and suicidal ideation/attempts. METHODS:We used longitudinal data from a national representative sample of the US adult population, the National Epidemiologic Survey on Alcohol and Related Conditions. Participants (n = 34 653) were interviewed in 2001-2002 (wave 1) and re-interviewed approximately 3 years later (wave 2). A propensity score analysis estimated the association between exposure to prescription opioids at wave 1 and prevalent/incident suicidal behavior at wave 2. RESULTS:Heavy/frequent (⩾2-3 times a month) prescription opioid use was associated with prevalent suicide attempts [adjusted risk ratio (ARR) = 2.75, 95% CI 1.35-5.60]. Prescription opioid use disorder was associated with prevalent (ARR = 1.98, 95% CI 1.20-3.28) and incident suicidal ideation (ARR = 2.59, 95% CI 1.25-5.37), and prevalent attempts (ARR = 4.19, 95% CI 1.71-10.27). None of the exposures was associated with incident suicide attempts. CONCLUSIONS:Heavy/frequent opioid use and related disorder were associated with prevalent suicide attempts; opioid use disorder was also associated with the incident and prevalent suicidal ideation. Given population increases in nonmedical use of prescription opioids and disorder, the opioid crisis may have contributed to population increases in suicidal ideation.
PMID: 32635959
ISSN: 1469-8978
CID: 4517342
Association of Recreational Cannabis Laws in Colorado and Washington State With Changes in Traffic Fatalities, 2005-2017
Importance/UNASSIGNED:An important consequence of cannabis legalization is the potential increase in the number of cannabis-impaired drivers on roads, which may result in higher rates of traffic-related injuries and fatalities. To date, limited information about the effects of recreational cannabis laws (RCLs) on traffic fatalities is available. Objective/UNASSIGNED:To estimate the extent to which the implementation of RCLs is associated with traffic fatalities in Colorado and Washington State. Design, Setting, and Participants/UNASSIGNED:This ecological study used a synthetic control approach to examine the association between RCLs and changes in traffic fatalities in Colorado and Washington State in the post-RCL period (2014-2017). Traffic fatalities data were obtained from the Fatality Analysis Reporting System from January 1, 2005, to December 31, 2017. Data from Colorado and Washington State were compared with synthetic controls. Data were analyzed from January 1, 2005, to December 31, 2017. Main Outcome(s) and Measures/UNASSIGNED:The primary outcome was the rate of traffic fatalities. Sensitivity analyses were performed (1) excluding neighboring states, (2) excluding states without medical cannabis laws (MCLs), and (3) using the enactment date of RCLs to define pre-RCL and post-RCL periods instead of the effective date. Results/UNASSIGNED:Implementation of RCLs was associated with increases in traffic fatalities in Colorado but not in Washington State. The difference between Colorado and its synthetic control in the post-RCL period was 1.46 deaths per 1 billion vehicle miles traveled (VMT) per year (an estimated equivalent of 75 excess fatalities per year; probability = 0.047). The difference between Washington State and its synthetic control was 0.08 deaths per 1 billion VMT per year (probability = 0.674). Results were robust in most sensitivity analyses. The difference between Colorado and synthetic Colorado was 1.84 fatalities per 1 billion VMT per year (94 excess deaths per year; probability = 0.055) after excluding neighboring states and 2.16 fatalities per 1 billion VMT per year (111 excess deaths per year; probability = 0.063) after excluding states without MCLs. The effect was smaller when using the enactment date (24 excess deaths per year; probability = 0.116). Conclusions and Relevance/UNASSIGNED:This study found evidence of an increase in traffic fatalities after the implementation of RCLs in Colorado but not in Washington State. Differences in how RCLs were implemented (eg, density of recreational cannabis stores), out-of-state cannabis tourism, and local factors may explain the different results. These findings highlight the importance of RCLs as a factor that may increase traffic fatalities and call for the identification of policies and enforcement strategies that can help prevent unintended consequences of cannabis legalization.
PMCID:7309574
PMID: 32568378
ISSN: 2168-6114
CID: 4492742
Opioid Use Disorder Treatment Facilities With Programs for Special Populations
INTRODUCTION/BACKGROUND:Special populations, including veterans, pregnant and postpartum women, and adolescents, benefit from opioid use disorder treatment tailored to their specific needs, but access to such services is poorly described. This study identifies the availability of opioid use disorder treatment facilities that use medications and have special programming and contextualizes facilities amid counties' opioid-related overdose mortality. METHODS:Data were compiled on 15,945 U.S. treatment facilities using medications for opioid use disorder listed in the Behavioral Health Services Treatment Locator in 2018. Facilities with programs tailored to special populations (veterans, pregnant and postpartum women, and adolescents) were identified and geocoded. Counties with such facilities were characterized. Cold spots (county clusters with poor treatment availability) were identified using Getis-Ord Gi* statistics. Data were extracted in October 2018 and analyzed from October 2018 to May 2019. RESULTS:Of all 3,142 U.S. counties, 1,889 (60.1%) had opioid use disorder treatment facilities. Facilities with tailored programs for veterans, pregnant and postpartum women, and adolescents were located in 701 (22.3%), 918 (29.2%), and 1,062 (33.8%) of the counties, respectively. Specific medications provided for opioid use disorder varied, with only a minority of facilities offering methadone (among facilities with tailored programs for veterans, 6.0%; pregnant and postpartum women, 13.2%; adolescents, 1.3%). Many counties reporting opioid-related overdose deaths lacked programs for special populations (veterans, 72.6%; pregnant and postpartum women, 54.8%; adolescents, 30.6%). Cold spots were located throughout the Midwest, U.S. Southeast, and portions of Texas. CONCLUSIONS:Facilities using medications for opioid use disorder with tailored programs for veterans, pregnant and postpartum women, and adolescents are limited. There is a need for improved access to evidence-based programs that address the unique treatment needs of special populations.
PMID: 32448551
ISSN: 1873-2607
CID: 4458132
Association between unintentional injuries and self-harm among adolescent emergency department patients
BACKGROUND:Unintentional injury, a leading cause of morbidity among adolescents, may also be a risk factor for deliberate self-harm. To inform clinical and public health prevention efforts in adolescent populations, we examined whether distinct subtypes of unintentional injury were differentially associated with deliberate self-harm. METHODS:Statewide, all-payer, individually linkable administrative data on adolescent patients presenting to any California emergency department (ED) in 2010 (n = 490,071) were used to investigate longitudinal associations between subtypes of unintentional injury and deliberate self-harm. Adolescents aged 10-19 years presenting with unintentional drug poisoning, other poisoning, fall, suffocation, or cutting/piercing injuries formed the exposure groups; adolescents presenting with unintentional strike injuries formed the primary referent group. Study patients were followed back in time (2006-2009) to compare the groups' odds of a prior ED visit for deliberate self-harm, as well as forwards in time (2010-2015) to compare their risks of subsequent self-harm. RESULTS:Unintentional drug-poisoning injury was strongly associated with increased likelihood of ED visits for deliberate self-harm, assessed both retrospectively (adjusted OR = 4.52; 95% confidence interval [CI] = 3.08, 6.64) and prospectively (adjusted RR = 3.74; 95% CI = 3.03, 4.60). Positive associations with odds of prior self-harm and/or risk of subsequent self-harm were also observed for patients with unintentional non-drug poisoning, suffocation, and cutting/piercing injuries. CONCLUSIONS:Certain subtypes of unintentional injury, particularly drug poisoning, are strongly associated with risk for deliberate self-harm among adolescents, a finding with implications for targeting clinical assessment and intervention in emergency department settings. More research is needed to understand the mechanisms underlying these associations.
PMCID:7211429
PMID: 32304935
ISSN: 1873-7714
CID: 4429692
