Faculty Bibliography
Searched for:
person:cerdam01 or freids01 or hamill07 or krawcn01
Total Results:
1305
A clash of epidemics: Impact of the COVID-19 pandemic response on opioid overdose
Coronavirus disease 2019 (COVID-19) will have a lasting impact on public health. In addition to the direct effects of COVID-19 infection, physical distancing and quarantine interventions have indirect effects on health. While necessary, physical distancing interventions to control the spread of COVID-19 could have multiple impacts on people living with opioid use disorder, including impacts on mental health that lead to greater substance use, the availability of drug supply, the ways that people use drugs, treatment-seeking behaviors, and retention in care. The degree to which COVID-19 will impact the opioid epidemic and through which of the possible mechanisms that we discuss is important to monitor. We employed simulation modeling to demonstrate the potential impact of physical distancing on overdose mortality.
PMCID:7536128
PMID: 33298298
ISSN: 1873-6483
CID: 4709032
A Critical Review of the Social and Behavioral Contributions to the Overdose Epidemic
More than 750,000 people in the United States died from an overdose between 1999 and 2018; two-thirds of those deaths involved an opioid. In this review, we present trends in opioid overdose rates during this period and discuss how the proliferation of opioid prescribing to treat chronic pain, changes in the heroin and illegally manufactured opioid synthetics markets, and social factors, including deindustrialization and concentrated poverty, contributed to the rise of the overdose epidemic. We also examine how current policies implemented to address the overdose epidemic may have contributed to reducing prescription opioid overdoses but increased overdoses involving illegal opioids. Finally, we identify new directions for research to understand the causes and solutions to this critical public health problem, including research on heterogeneous policy effects across social groups, effective approaches to reduce overdoses of illegal opioids, and the role of social contexts in shaping policy implementation and impact. Expected final online publication date for the Annual Review of Public Health, Volume 42 is April 1, 2021. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.
PMID: 33256535
ISSN: 1545-2093
CID: 4693962
Adapting a Low-threshold Buprenorphine Program for Vulnerable Populations During the COVID-19 Pandemic
OBJECTIVES/OBJECTIVE:To examine patient characteristics and outcomes among opioid use disorder patients enrolled in low-threshold buprenorphine treatment during the COVID-19 pandemic. METHODS:This paper describes the adaptation of the Project Connections (PC) program, a low-threshold buprenorphine program in Baltimore, in response to the COVID-19 pandemic. This paper examines patient characteristics and initial outcomes of patients served during a rapid protocol shift to telehealth that allowed buprenorphine initiation without an in-person encounter following a state-mandated stay-at-home order. Patient characteristics were compared to a subsample of patients enrolled in the program before the COVID-19 pandemic. RESULTS:In March 2020, there was a sharp increase in new enrollments to the PC program. A total of 143 patients completed an intake assessment between March and May 2020 and 140 began treatment with buprenorphine/naloxone. Those who completed an intake assessment were primarily male (68.5%), Black (83.2%), had a mean age of 43.2 years (SD = 11.7), and reported a mean of 17.0 years of opioid use (SD = 12.9). The majority of patients were unemployed (72.7%) and reported previous criminal justice involvement (69.2%). Of those who completed an intake assessment, 96.5% returned for a second visit. Among those for whom 30-day retention data was available (n = 113), 63.7% were engaged for 30 days or longer. CONCLUSIONS:The PC program illustrates that offering on-demand, flexible treatment is an opportunity to increase opioid use disorder treatment access, even during a public health emergency that disrupted access to services. Relaxation of buprenorphine telehealth regulations allowed for flexibility in treatment and benefits vulnerable populations.
PMID: 33177436
ISSN: 1935-3227
CID: 4665332
Trajectories of and disparities in HIV prevalence among Black, white, and Hispanic/Latino men who have sex with men in 86 large U.S. metropolitan statistical areas, 1992-2013
PURPOSE/OBJECTIVE:The challenges of producing adequate estimates of HIV prevalence among men who have sex with men (MSM) are well known. No one, to our knowledge, has published annual estimates of HIV prevalence among MSM over an extended period and across a wide range of geographic areas. METHODS:This article applies multilevel modeling to data integrated from numerous sources to estimate and validate trajectories of HIV prevalence among MSM from 1992 to 2013 for 86 of the largest metropolitan statistical areas in the United States. RESULTS:Our estimates indicate that HIV prevalence among MSM increased, from an across-metropolitan statistical area mean of 11% in 1992 to 20% in 2013 (S.D. = 3.5%). Our estimates by racial/ethnic subgroups of MSM suggest higher mean HIV prevalence among black and Hispanic/Latino MSM than among white MSM across all years and geographic regions. CONCLUSIONS:The increases found in HIV prevalence among all MSM are likely primarily attributable to decreases in mortality and perhaps also to increasing HIV incidence among racial/ethnic minority MSM. Future research is needed to confirm this. If true, health care initiatives should focus on targeted HIV prevention efforts among racial/ethnic minority MSM and on training providers to address cross-cutting health challenges of increased longevity among HIV-positive MSM.
PMID: 32950653
ISSN: 1873-2585
CID: 4660242
Predicting the Future Course of Opioid Overdose Mortality: An Example from Two US States
BACKGROUND:The rapid growth of opioid abuse and related mortality across the United States has spurred the development of predictive models for the allocation of public health resources. These models should characterize heterogeneous growth across states using a drug epidemic framework that enables assessments of epidemic onset, rates of growth, and limited capacities for epidemic growth. METHODS:We used opioid overdose mortality data for 146 North and South Carolina counties from 2001 through 2014 to compare the retrodictive and predictive performance of a logistic growth model that parameterizes onsets, growth, and carrying capacity within a traditional Bayesian Poisson space-time model. RESULTS:In fitting the models to past data, the performance of the logistic growth model was superior to the standard Bayesian Poisson space-time model (deviance information criterion: 8088 vs. 8256), with reduced spatial and independent errors. Predictively, the logistic model more accurately estimated fatality rates 1, 2, and 3 years in the future (root mean squared error medians were lower for 95.7% of counties from 2012 to 2014). Capacity limits were higher in counties with greater population size, percent population age 45 to 64, and percent white population. Epidemic onset was associated with greater same-year and past-year incidence of overdose hospitalizations. CONCLUSION/CONCLUSIONS:Growth in annual rates of opioid fatalities was capacity limited, heterogeneous across counties, and spatially correlated, requiring spatial epidemic models for the accurate and reliable prediction of future outcomes related to opioid abuse. Indicators of risk are identifiable and can be used to predict future mortality outcomes.
PMID: 33002963
ISSN: 1531-5487
CID: 4617182
Firearm suicide mortality among emergency department patients with physical health problems
PURPOSE/OBJECTIVE:Individuals with poor physical and mental health may face elevated risk for suicide, particularly suicide by firearm. METHODS:This retrospective cohort study used statewide, longitudinally-linked ED patient record and mortality data to examine 12-month incidence of firearm suicide among emergency department (ED) patients presenting with a range of physical health problems. Participants included all residents presenting to a California ED in 2009-2013 with nonfatal visits for somatic diagnoses hypothesized to increase suicide risk, including myocardial infarction, congestive heart failure, cerebrovascular disease, chronic obstructive pulmonary disease, diabetes, cancer, back pain, headache, joint disorder, and injuries. For each patient diagnostic group, we calculated rates of firearm suicide per 100,000 person-years and standardized mortality ratios (SMRs) relative to the demographically matched California population. RESULTS:Firearm suicide rates per 100,000 person-years ranged from 9.6 (among patients presenting with unintentional injury) to 55.1 (patients with cancer diagnoses), with SMRs from 1.48 to 7.45 (all p<0.05). SMRs for patients with cardiovascular conditions ranged from 2.45 to 5.10. Males and older individuals had higher firearm suicide rates, and there was substantial between-group variability in the proportion of suicide decedents who used a firearm. CONCLUSIONS:ED patients presenting with deliberate self-harm injuries, substance use, and cancer were especially at risk for firearm suicide. To avoid missed suicide-prevention opportunities, EDs should implement evidence-based suicide interventions as a best practice for their patients.
PMID: 32950655
ISSN: 1873-2585
CID: 4616212
Identifying sensitive periods when changes in parenting and peer factors are associated with changes in adolescent alcohol and marijuana use
PURPOSE/OBJECTIVE:There are well-established associations between parental/peer relationships and adolescent substance use, but few longitudinal studies have examined whether adolescents change their substance use in response to changes in their parents' behavior or peer networks. We employ a within-person change approach to address two key questions: Are changes in parenting and peer factors associated with changes in adolescent marijuana and alcohol use? Are there sensitive periods when changes in parenting and peer factors are more strongly associated with changes in adolescent marijuana and alcohol use? METHODS:We analyzed longitudinal data collected annually on 503 boys, ages 13-19, recruited from Pittsburgh public schools. Questionnaires regarding parental supervision, negative parenting practices, parental stress, physical punishment, peer delinquency, and peer drug use were administered to adolescents and their caretakers. Alcohol and marijuana use were assessed by a substance use scale adapted from the National Youth Survey. RESULTS:Reductions in parental supervision and increases in peer drug use and peer delinquency were associated with increases in marijuana frequency, alcohol frequency, and alcohol quantity. Increases in parental stress were associated with increases in marijuana and alcohol frequency. The magnitudes of these relationships were strongest at ages 14-15 and systematically decreased across adolescence. These associations were not due to unmeasured stable confounders or measured time-varying confounders. CONCLUSIONS:Reducing or mitigating changes in parenting and peer risk factors in early adolescence may be particularly important for preventing substance use problems as adolescents transition into young adulthood.
PMID: 32915245
ISSN: 1433-9285
CID: 4589632
Assessment of the impact of implementation of a zero-blood alcohol concentration law in Uruguay on moderate/severe injury and fatal crashes: a quasi-experimental study
BACKGROUND AND AIMS/OBJECTIVE:Debates about lowering the blood alcohol concentration (BAC) limit for drivers are intensifying in the United States and other countries, and the World Health Organization recommends the limit for adults should be 0.05%. In January 2016, Uruguay implemented a law setting zero-BAC limit for all drivers. This aimed to assess the effect of this policy on the frequency of moderate/severe-injury and fatal traffic crashes. DESIGN/METHODS:A quasi experimental study in which a synthetic control model was used with controls consisting of local areas in Chile as the counterfactual for outcomes in Uruguay, matched across population counts and pre-intervention period outcomes. Sensitivity analyses were also conducted. SETTING/METHODS:Uruguay and Chile. CASES/METHODS:Panel data with crash counts by outcome per locality-month (2013-2017). INTERVENTION AND COMPARATOR/UNASSIGNED:A zero-blood alcohol concentration law implemented 9 Jan 2016 in Uruguay, alongside a continued 0.03g/dL BAC threshold in Chile. MEASUREMENTS/METHODS:Per capita moderate/severe injury (i.e., moderate or severe), severe injury, and fatal crashes (2016-2017). FINDINGS/RESULTS:Our base synthetic control model results suggested a reduction in fatal crashes at 12 months (20.9%; p-value=0.018, 95% CI: [-0.340, -0.061]). Moderate-/severe-injury crashes did not decrease significantly (10.2%, p=0.312 [-.282, .075]). The estimated effect at 24 months was smaller and with larger confidence intervals for fatal crashes (14%; p =0.048 [-.246, -.026]) and largely unchanged for moderate/severe-injury crashes (-9.4%, p=.302 [-.248, .075]). Difference-in-differences analyses yielded similar results. As a sensitivity test, a synthetic control model relying on an inferior treatment-control match pre-intervention (measured by mean squared error) yielded similar sized differences that were not statistically significant. CONCLUSIONS:Implementation of a law setting a zero blood-alcohol concentration threshold for all drivers in Uruguay appears to have resulted in a reduction in fatal crashes in the following 12 months and 24 months.
PMID: 32830394
ISSN: 1360-0443
CID: 4575052
COVID-19 During the Opioid Epidemic - Exacerbation of Stigma and Vulnerabilities
PMID: 32277731
ISSN: 1748-0361
CID: 4403182
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
