Faculty Bibliography

BACKGROUND:Individuals with opioid use disorder (OUD) may experience fewer barriers to treatment following incarceration if offered in-jail medications for OUD (MOUD). We aimed to identify care trajectories of community OUD treatment after incarceration and examine the association between receiving in-jail MOUD and experiencing specific community treatment trajectories. METHODS:This retrospective cohort study using matched New York City (NYC) health care administrative data included adults with OUD incarcerated on or after May 2011 and discharged during 2014-2017. We defined states of community OUD treatment at the weekly level over one year following index jail discharge and performed state sequence analysis (SSA) to identify trajectories of treatment after jail and assessed the influence of receiving in-jail MOUD on treatment trajectories. RESULTS:Of 14,923 eligible individuals, 26.2% received in-jail MOUD. SSA identified eight clusters of community care trajectories: continuous methadone treatment (9.7%), methadone treatment discontinuation (3.7%), methadone treatment and reincarceration (6.7%), methadone treatment initiation (4.8%), continuous reincarceration (3.5%), short reincarceration with little community treatment (20.3%), long reincarceration with little community treatment (7.0%), and no community OUD treatment or reincarceration (44.5%). Receiving in-jail MOUD was associated with belonging to the continuous methadone treatment cluster compared to the no community OUD treatment or reincarceration cluster (adjusted OR: 12.5, 95% CI: 9.9-15.7). CONCLUSION/CONCLUSIONS:We identified eight unique patterns of community OUD treatment after jail release. Receipt of in-jail MOUD was associated with belonging to the continuous methadone treatment cluster. These findings suggest that provision of in-jail MOUD could improve methadone uptake in the community.

Overdose prevention centers (OPCs) are associated with improved community health and decreased crime, but opponents argue that OPCs depress nearby property values. We estimated the association of the opening of the first two public recognized OPC in the United States with neighborhood residential rents and real estate sales in the East Harlem and Washington Heights neighborhoods of New York City (NYC). Using augmented synthetic controls, we analyzed quarterly and semiannual rental listings and annual and semiannual sales within 300- and 500-meter buffers around the OPCs. Donor units were buffers around syringe service programs without OPCs and opioid treatment programs. Primary outcomes were median quarterly rental listing price and median annual sales price. Overall, we found no changes in neighborhood rental or sales prices. For quarterly rentals at 300 m, we estimated (ATT, 95% CI) $145 (-$780, $1070) in East Harlem and -$505 (-$1279, $269) in Washington Heights. For annual sales at 500 m, we estimated -$542 993 (-$1 228 024, $142038) in East Harlem and $1 121 706 (-$431 285, $2674697) in Washington Heights. Conformal inference identified no detectable time-point effects. Overall, OPC implementation in NYC was not associated with changes in rents or sales, suggesting these facilities may not generate appreciable effects on local housing values.

Stigma in healthcare settings is a critical barrier to HIV prevention and treatment among people who inject drugs (PWID). While previous tools have measured anticipated stigma, few account for the intersectional and provider-specific experiences of PWID-particularly from syringe service programs (SSPs). We developed and validated the Substance Use Anticipated Provider Stigma Scale (SU-APSS), a multidimensional instrument assessing anticipated stigma from four provider types: healthcare workers, substance use treatment staff, pharmacists, and SSP personnel. Data were drawn from a cross-sectional survey of 264 PWID who were 18 or older, HIV-negative, had injected drugs and used opioids within the past 30 days, and showed visible signs of recent injection. We conducted confirmatory factor analysis (CFA) on responses from 218 participants to evaluate structural validity and used Cronbach's alpha to assess internal consistency. The CFA supported a four-factor structure with strong model fit indices (CFI = 0.97, RMSEA = 0.09 [0.07, 0.11], SRMR = 0.04). All items significantly loaded onto their respective factors (loadings: 0.62-1.06). Internal consistency was high across all subscales (α = 0.85-0.96) and for the overall scale (α = 0.87). Attribution analysis revealed drug use, physical appearance, and income level as the most common perceived reasons for anticipated stigma. The SU-APSS offers a practical tool for identifying provider-specific stigma, informing stigma-reduction interventions, and evaluating implementation strategies to improve HIV prevention and care engagement among PWID.

BACKGROUND AND AIMS/OBJECTIVE:The opioid crisis is still a public health emergency in the United States, despite recent declines in opioid overdose deaths (OODs) and increased availability of evidence-based practices (EBPs) for opioid use disorder (OUD). The geographic variability in OODs drives the need for localized decision-making, where interventions are tailored to the unique needs of communities. This study aimed to develop and calibrate a simulation model that evaluates the impact of enhanced implementation of EBP on OODs at the community-level. DESIGN/METHODS:We developed OPSiM (Opioid Policy Simulation Model), a community-level microsimulation model that simulates the course of opioid use, OUD, treatment, recovery and overdose-related events. The model was parameterized with data from the HEALing Communities Study and looked at six scenarios of EBPs implemented in 2025 with sustainment through 2030: (1) maintain 2024 EBP levels (status quo); (2) increase initiation of medications for opioid use disorder (MOUD); (3) increase MOUD retention; (4) increase MOUD initiation and retention; (5) increase distribution of naloxone; and (6) both scenarios 4 and 5. SETTING/METHODS:Twenty-nine communities in Massachusetts, New York, and Ohio, USA. PARTICIPANTS/METHODS:Simulated community residents with non-prescribed opioid use or OUD. MEASUREMENTS/METHODS:Estimated number of OODs per 100 000 individuals between 2025 and 2030 in each community, averaged across the 26 communities. FINDINGS/RESULTS:Under the status quo, the model projected 158 OODs (range across communities: 39-468) per 100 000 individuals between 2025 and 2030. Increasing medications for the treatment of OUD (MOUD) retention alone reduced OODs by 6% (range: 3-15%), while increasing MOUD initiation alone reduced OODs by 9% (range: 8-12%). Increasing both MOUD initiation and retention had a synergistic effect, reducing OODs by 21% (range: 15-31%). Reduction in OODs in response to increased MOUD initiation and/or retention was similar across urban and rural communities. The effect of increasing naloxone distribution varied substantially across communities due to differing saturation levels; in some communities, additional naloxone kits provided only marginal benefits. Rural communities were further from saturation whereas most urban communities were at or close to saturation. CONCLUSIONS:A tailored, multi-pronged approach that scales up medications for opioid use disorder alongside widespread naloxone distribution, and that addresses community-specific needs and capacities, will be most effective at reducing opioid overdose deaths in the United States.

BACKGROUND:Between 2022 and 2023, overdose mortality decreased among non-Hispanic (NH) white people but stayed the same or increased among people of colour in the USA. County racialised economic segregation may contribute to overdose mortality. METHODS:measures, one for higher-income NH white and lower-income black residents and another for higher-income NH white and lower-income Hispanic residents. Models included random effects for county, year and county-year interaction, and fixed effects for proportion male, proportion aged 25-44, land area, state and year. We estimated relative risk (RR) by quintile (least vs most privileged) and the difference in overdose mortality per 100 000 (RD) had all counties shifted to the risk of the most advantaged counties (Q5). RESULTS:Counties with the highest proportion of lower-income racially minoritised residents (Q1) had an increased RR of overdose deaths compared with Q5 counties, both overall (aRRs 1.64 (1.51-1.78); 1.40 (1.29-1.52)), and among subgroups. Had all counties experienced the risk of Q5 counties, we estimated an average reduction in overdose deaths overall (RDs per 100 000: -7.20 (-8.25 to -6.10); -6.37 (-7.38 to -5.25)) and among subgroups. CONCLUSION/CONCLUSIONS:County racialised economic segregation was associated with overdose mortality risk in 2018-2022. Investment in evidence-based strategies to reduce overdose risk in places experiencing harms related to racialised economic segregation is critical.

BACKGROUND:Methadone is a highly effective, strictly regulated medication to treat opioid use disorder. COVID-19 flexibilities allowed for up to 28 days of take-homes versus daily travel to clinics for observed dosing, but receiving take-homes differed widely across clinics and individuals. We examined the relationship between state take-home policies and social vulnerability on take-home methadone receipt and days' supply. METHODS:Data were from the VOICES study, a telephone survey conducted between 1/2023-8/2024 of people who use drugs from Wisconsin, Michigan, New Mexico, and New Jersey. We estimated average marginal effects of state methadone policy (flexibility-adoption vs non-adoption) on methadone take-home receipt and days' supply. Models were fully adjusted for individual sociodemographic characteristics. RESULTS:Most participants were recruited from flexibility-adoption states (n = 285/428, 67%). Over half received take-home methadone (65%; average 3.1 days' supply, SD 6.2); 19% of take-home recipients (n = 54) received ≥3 days' supply. Take-home receipt was higher for participants in flexibility-adoption states (AME 0.52, p < 0.0001). Receiving ≥3 days' supply was lower in people reporting unemployment (vs. employment, AME -0.23, p = 0.0032) and past 30-day drug use (vs. no drug use, AME -0.23, p = 0.0014). CONCLUSIONS:State take-home policy was most strongly associated with take-home methadone receipt. Receiving longer days of take-home supplies remains rare. Take-home eligibility guidelines should be established and consider potential social vulnerability factors to daily on-site dosing.

IMPORTANCE/UNASSIGNED:Overdose prevention centers (OPCs) are interventions to reduce overdose mortality and support health care engagement. In the US, concerns have been raised that OPCs may be associated with reduced economic activity in their surrounding neighborhoods. OBJECTIVE/UNASSIGNED:To evaluate changes in the local economic activity in New York City (NYC), measured by neighborhood-level foot traffic and consumer spending, following the opening of the first 2 publicly recognized OPCs in the US. DESIGN, SETTING, AND PARTICIPANTS/UNASSIGNED:This cohort study used anonymized mobility and spending data from June 1, 2021, to June 13, 2022, for the areas surrounding the East Harlem and Washington Heights OPCs in NYC. These neighborhoods were defined using 5-minute and 10-minute walking buffers and Business Improvement Districts (BIDs). Synthetic control donors included walking buffers and BIDs around syringe service programs without OPCs and opioid treatment programs that were operational as of OPCs' opening. Analyses were conducted from February to July 2025. EXPOSURES/UNASSIGNED:Opening of the 2 NYC OPCs on November 30, 2021. MAIN OUTCOMES AND MEASURES/UNASSIGNED:Primary outcomes were foot traffic and in-person consumer spending within 10-minute walking buffers. Secondary analyses considered 5-minute walking buffers and BIDs. Augmented synthetic control models were adjusted for neighborhood-level demographic and socioeconomic features, with fit assessed using root mean squared error before OPC opening. Permutation tests and conformal inference were used to assess significance. RESULTS/UNASSIGNED:A total of 27 biweekly observations (13 in pre-OPC and 14 in post-OPC periods) were analyzed. The 10-minute walking buffer analyses captured 1259 consumer spending sites and 7816 foot traffic sites across 2 treated buffers and 56 donor buffers. In East Harlem, the average treatment effect on the treated (ATT) estimate (SE) was -$21.96 ($40.53) for consumer spending (P = .16) and 1.28 (5.40) visits for foot traffic (P = .19). In Washington Heights, ATT (SE) estimates were $14.94 ($37.38) for consumer spending (P = .13) and 0.44 (3.54) visits for foot traffic (P = .97). Secondary analyses produced consistent results. No statistically significant results were observed at any post-OPC time point. CONCLUSIONS AND RELEVANCE/UNASSIGNED:This cohort study found that OPC opening was not associated with significant changes in local economic activity. Given the absence of observed economic harms, policy debates should instead focus on the public health implications of OPCs.

IMPORTANCE/UNASSIGNED:There has been a national increase in fatal and nonfatal overdoses involving stimulants, and 4.5 million US individuals meet criteria for stimulant use disorder (UD), with the highest prevalence in young adults. However, limited information exists on trends in diagnosed stimulant UD. OBJECTIVE/UNASSIGNED:To estimate trends in the proportion of adolescent and young adult Medicaid enrollees diagnosed with a stimulant UD from 2001 to 2020. DESIGN, SETTING, AND PARTICIPANTS/UNASSIGNED:A repeated cross-sectional study (2001-2020) was conducted using administrative health care claims data from Medicaid (public insurance program in US). Publicly insured adolescents (aged 13-17 years) and young adults (aged 18-24 or 25-29 years) from 42 US states were included. Data were analyzed from January 2025 to July 2025. MAIN OUTCOMES AND MEASURES/UNASSIGNED:Stimulant UD was defined as an inpatient or outpatient International Classification of Diseases diagnosis code in the year, with cocaine UD and noncocaine psychostimulant UD evaluated separately. The annual proportion with stimulant UD diagnoses was stratified by age group, sex, race and ethnicity, and presence of attention-deficit/hyperactivity disorder (ADHD) diagnosis or stimulant prescription in the year. Differences comparing 2001 with 2020 were summarized. Characteristics of those diagnosed with stimulant UD in 2020 were described. RESULTS/UNASSIGNED:The sample included 5.7 million (2001) to 16.1 million Medicaid enrollees (2020) per year; in 2020, 54.2% were female, and 7.1 million were adolescents. From 2001 to 2020, the proportion diagnosed with noncocaine psychostimulant UD increased from 0.09% to 0.49% (prevalence ratio [PR], 5.47 [95% CI, 5.20-5.75]) in those aged 18 to 24 years, from 0.13% to 1.63% (PR, 12.55 [95% CI, 11.83-13.31]) for ages 25 to 29 years, and from 0.10% to 0.91% among young adults aged 18 to 29 years. Among adolescents, the proportion diagnosed with noncocaine psychostimulant UD varied between 0.03% and 0.07%. The proportion diagnosed with cocaine UD was stable in young adults (range, 0.17%-0.34% [18-24 years] and 0.53%-0.79% [25-29 years]) and declined in adolescents (from 0.04% to 0.01%). Cocaine and noncocaine psychostimulant UD diagnoses were 2 to 4 times more common in patients with an ADHD diagnosis or stimulant prescription. Most patients diagnosed with a stimulant UD in 2020 were also diagnosed with a mental health disorder (68%-82%) or other substance UD (72%-78%). CONCLUSIONS AND RELEVANCE/UNASSIGNED:The prevalence of noncocaine psychostimulant UD diagnoses in young adult Medicaid patients increased over the last 2 decades, potentially associated with an increasing use of prescription and illicit stimulants along with increased clinical detection. These trends raise concerns given recent rises in stimulant-involved overdose fatalities and stress the need for evidence-based stimulant UD treatments for young people.