Faculty Bibliography

Increasing alcohol outlet density is well-documented to be associated with increased alcohol use and problems, leading to the policy recommendation that limiting outlet density will decrease alcohol problems. Yet few studies of decreasing problematic outlets and outlet density have been conducted. We estimated the association between closing alcohol outlets and alcohol use and alcohol-related violence, using an agent-based model of the adult population in New York City. The model was calibrated according to the empirical distribution of the parameters across the city's population, including the density of on- and off-premise alcohol outlets. Interventions capped the alcohol outlet distribution at the 90th up to the 50th percentiles of the New York City density, and closed 5% to the 25% of outlets with the highest levels of violence. Capping density led to a lower population of light drinkers (42.2% at baseline vs. 38.1% at the 50th percentile), while heavy drinking increased slightly (12.0% at baseline vs. 12.5% at the 50th percentile). Alcohol-related homicides and non-fatal violence remained unchanged. Closing violent outlets was not associated with changes in alcohol use or related problems. Results suggest that focusing solely on closing alcohol outlets may not be an effective strategy to reduce alcohol-related problems.

BACKGROUND AND AIMS/OBJECTIVE:Prescription drug monitoring programs (PDMP), defined as state-level databases used in the USA that collect prescribing information when controlled substances are dispensed, have varied substantially between states and over time. Little is known about the combinations of PDMP features that, collectively, may produce the greatest impact on prescribing and overdose. We aimed to (1) identify the types of PDMP models that have developed from 1999 to 2016, (2) estimate whether states have transitioned across PDMP models over time, and (3) examine whether states have adopted different types of PDMP models in response to the burden of opioid overdose. METHODS:A latent transition analysis of PDMP models based on an adaptation of nine PDMP characteristics classified by prescription opioid policy experts as potentially important determinants of prescribing practices and prescription opioid overdose events. RESULTS:We divided the time period into three intervals (1999-2004, 2005-2009, 2010-2016), and found three distinct PDMP classes in each interval. The classes in the first and second interval can be characterized as "No/Weak", "Proactive", and "Reactive" types of PDMPs, and in the third interval as "Weak", "Cooperative", and "Proactive". The meaning of these classes changed over time: until 2009, states in the "No/Weak" class had no active PDMP, whereas states in the "Proactive" class were more likely to proactively provide unsolicited information to PDMP users, provide open access to law enforcement, and require more frequent data reporting than states in the "Reactive" class. In 2010-2016, the "Weak" class resembled the "Reactive" class in previous intervals. States in the "Cooperative" class in 2010-2016 were less likely than states in the "Proactive" class proactively to provide unsolicited reports, or to provide open access to law enforcement; however, they were more likely than those in the "Proactive" class to share PDMP data with other states, and to report more federal drug schedules. CONCLUSIONS:Since 1999, US states have tended to transition to more robust classes of prescription drug monitoring programs (PDMPs). Opioid overdose deaths in prior years predicted the state's PDMP class but did not predict transitions between PDMP classes over time.

"10:10 a.m., September 11, 2001" -- "Becoming an 'Other'" -- "Remember" -- "Little things"

Despite the high incidence of HIV among young Black MSM in the United States and engagement in high risk behaviors, many men in this group avoid infection. This suggests that some men may engage in systematic risk reduction behaviors when not always using condoms or abstaining from substances. Using a "positive deviance" framework, we conducted qualitative interviews with HIV-negative, Black MSM between 25 and 35 who reported unprotected anal sex and drug use in the past six months or current heavy drinking (N = 29) to discover behaviors that could facilitate remaining HIV-uninfected. Findings showed that MSM who remain HIV negative despite continuing to engage in high-risk behaviors may be engaging in adaptive risk reduction behaviors that, through successive decisions and advance planning along the timeline to a sexual event, could lead to increased condom use, avoidance or delay of a risky sexual event, or reduction of HIV positive partners.

OBJECTIVES:To present and discuss recent patterns of prescription opioid sales throughout Brazil. METHODS:We graphed linear trends of opioid prescriptions sold from registered pharmacies across Brazil from 2009 to 2015. We then calculated the change in rate of prescriptions sold per 1000 persons in 2015 compared with 2009. RESULTS:Opioid sales increased across Brazil from 1 601 043 prescriptions in 2009 to 9 045 945 prescriptions in 2015, corresponding to a 465% increase in 6 years. The largest absolute increase was for codeine products (rate ratio (RR) = 5.30; 95% confidence interval [CI] = 5.29, 5.31), accounting for more than 98% of prescriptions in both years. Oxycodone had the largest relative increase (RR = 11.39; 95% CI = 11.19, 11.59), and fentanyl products had the smallest absolute and relative increase (RR = 2.91; 95% CI = 2.78, 3.03). CONCLUSIONS:Given rapid increases in opioid sales across Brazil, it is critical to introduce effective prescribing and monitoring methods that allow patients to access necessary medications without escalating risk of opioid misuse and related consequences. Careful surveillance of supply and subsequent outcomes are needed to prevent the development of another devastating opioid epidemic in the Americas.