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Characterizing opioid overdose hotspots for place-based overdose prevention and treatment interventions: A geo-spatial analysis of Rhode Island, USA

Samuels, Elizabeth A; Goedel, William C; Jent, Victoria; Conkey, Lauren; Hallowell, Benjamin D; Karim, Sarah; Koziol, Jennifer; Becker, Sara; Yorlets, Rachel R; Merchant, Roland; Keeler, Lee Ann Jordison; Reddy, Neha; McDonald, James; Alexander-Scott, Nicole; Cerda, Magdalena; Marshall, Brandon D L
OBJECTIVE:Examine differences in neighborhood characteristics and services between overdose hotspot and non-hotspot neighborhoods and identify neighborhood-level population factors associated with increased overdose incidence. METHODS:We conducted a population-based retrospective analysis of Rhode Island, USA residents who had a fatal or non-fatal overdose from 2016 to 2020 using an environmental scan and data from Rhode Island emergency medical services, State Unintentional Drug Overdose Reporting System, and the American Community Survey. We conducted a spatial scan via SaTScan to identify non-fatal and fatal overdose hotspots and compared the characteristics of hotspot and non-hotspot neighborhoods. We identified associations between census block group-level characteristics using a Besag-York-Mollié model specification with a conditional autoregressive spatial random effect. RESULTS:We identified 7 non-fatal and 3 fatal overdose hotspots in Rhode Island during the study period. Hotspot neighborhoods had higher proportions of Black and Latino/a residents, renter-occupied housing, vacant housing, unemployment, and cost-burdened households. A higher proportion of hotspot neighborhoods had a religious organization, a health center, or a police station. Non-fatal overdose risk increased in a dose responsive manner with increasing proportions of residents living in poverty. There was increased relative risk of non-fatal and fatal overdoses in neighborhoods with crowded housing above the mean (RR 1.19 [95 % CI 1.05, 1.34]; RR 1.21 [95 % CI 1.18, 1.38], respectively). CONCLUSION/CONCLUSIONS:Neighborhoods with increased prevalence of housing instability and poverty are at highest risk of overdose. The high availability of social services in overdose hotspots presents an opportunity to work with established organizations to prevent overdose deaths.
PMID: 38245914
ISSN: 1873-4758
CID: 5624482

Retention and critical outcomes among new methadone maintenance patients following extended take-home reforms: a retrospective observational cohort study

Williams, Arthur Robin; Krawczyk, Noa; Hu, Mei-Chen; Harpel, Lexa; Aydinoglo, Nicole; Cerda, Magdalena; Rotrosen, John; Nunes, Edward V
BACKGROUND/UNASSIGNED:Approximately 1800 opioid treatment programs (OTPs) in the US dispense methadone to upwards of 400,000 patients with opioid use disorder (OUD) annually, operating under longstanding highly restrictive guidelines. OTPs were granted novel flexibilities beginning March 15, 2020, allowing for reduced visit frequency and extended take-home doses to minimize COVID exposure with great variation across states and sites. We sought to use electronic health records to compare retention in treatment, opioid use, and adverse events among patients newly entering methadone maintenance in the post-reform period in comparison with year-ago, unexposed, controls. METHODS/UNASSIGNED:Retrospective observational cohort study across 9 OTPs, geographically dispersed, in the National Institute of Drug Abuse (NIDA) Clinical Trials Network. Newly enrolled patients between April 15 and October 14, 2020 (post-COVID, reform period) v. March 15-September 14, 2019 (pre-COVID, control period) were assessed. The primary outcome was 6-month retention. Secondary outcomes were opioid use and adverse events including emergency department visits, hospitalizations, and overdose. FINDINGS/UNASSIGNED: INTERPRETATION/UNASSIGNED:Policies allowing for extended take-home schedules were not associated with worse retention or adverse events despite slightly elevated rates of measured opioid use while in care. Relaxed guidelines were not associated with measurable increased harms and findings could inform future studies with prospective trials. FUNDING/UNASSIGNED:USDHHSNIDACTNUG1DA013035-15.
PMCID:10751716
PMID: 38152421
ISSN: 2667-193x
CID: 5623252

Independent and joint contributions of physical disability and chronic pain to incident opioid use disorder and opioid overdose among Medicaid patients

Hoffman, Katherine L; Milazzo, Floriana; Williams, Nicholas T; Samples, Hillary; Olfson, Mark; Diaz, Ivan; Doan, Lisa; Cerda, Magdalena; Crystal, Stephen; Rudolph, Kara E
BACKGROUND:Chronic pain has been extensively explored as a risk factor for opioid misuse, resulting in increased focus on opioid prescribing practices for individuals with such conditions. Physical disability sometimes co-occurs with chronic pain but may also represent an independent risk factor for opioid misuse. However, previous research has not disentangled whether disability contributes to risk independent of chronic pain. METHODS:Here, we estimate the independent and joint adjusted associations between having a physical disability and co-occurring chronic pain condition at time of Medicaid enrollment on subsequent 18-month risk of incident opioid use disorder (OUD) and non-fatal, unintentional opioid overdose among non-elderly, adult Medicaid beneficiaries (2016-2019). RESULTS:We find robust evidence that having a physical disability approximately doubles the risk of incident OUD or opioid overdose, and physical disability co-occurring with chronic pain increases the risks approximately sixfold as compared to having neither chronic pain nor disability. In absolute numbers, those with neither a physical disability nor chronic pain condition have a 1.8% adjusted risk of incident OUD over 18 months of follow-up, those with physical disability alone have an 2.9% incident risk, those with chronic pain alone have a 3.6% incident risk, and those with co-occurring physical disability and chronic pain have a 11.1% incident risk. CONCLUSIONS:These findings suggest that those with a physical disability should receive increased attention from the medical and healthcare communities to reduce their risk of opioid misuse and attendant negative outcomes.
PMID: 37974483
ISSN: 1469-8978
CID: 5610482

Translating predictive analytics for public health practice: A case study of overdose prevention in Rhode Island

Allen, Bennett; Neill, Daniel B; Schell, Robert C; Ahern, Jennifer; Hallowell, Benjamin D; Krieger, Maxwell; Jent, Victoria A; Goedel, William C; Cartus, Abigail R; Yedinak, Jesse L; Pratty, Claire; Marshall, Brandon D L; Cerdá, Magdalena
Prior applications of machine learning to population health have relied on conventional model assessment criteria, limiting the utility of models as decision supports for public health practitioners. To facilitate practitioner use of machine learning as decision support for area-level intervention, this study developed and applied four practice-based predictive model evaluation criteria (implementation capacity, preventive potential, health equity, and jurisdictional practicalities). We used a case study of overdose prevention in Rhode Island to illustrate how these criteria could inform public health practice and health equity promotion. We used Rhode Island overdose mortality records from January 2016 to June 2020 (N=1,408) and neighborhood-level Census data. We learned two disparate machine learning models, Gaussian process and random forest, to illustrate the comparative utility of our criteria to guide interventions. Our models predicted 7.5-36.4% of overdose deaths during the test period, illustrating the preventive potential of overdose interventions assuming 5-20% statewide implementation capacities for neighborhood-level resource deployment. We described the health equity implications of predictive modeling to guide interventions along urbanicity, racial/ethnic composition, and poverty. In sum, our study discussed considerations to complement predictive model evaluation criteria and inform the prevention and mitigation of spatially dynamic public health problems across the breadth of practice.
PMID: 37204178
ISSN: 1476-6256
CID: 5480922

Increasing risk of cannabis use disorder among U.S. veterans with chronic pain: 2005-2019

Mannes, Zachary L; Malte, Carol A; Olfson, Mark; Wall, Melanie M; Keyes, Katherine M; Martins, Silvia S; Cerdá, Magdalena; Gradus, Jaimie L; Saxon, Andrew J; Keyhani, Salomeh; Maynard, Charles; Livne, Ofir; Fink, David S; Gutkind, Sarah; Hasin, Deborah S
In the United States, cannabis is increasingly used to manage chronic pain. Veterans Health Administration (VHA) patients are disproportionately affected by pain and may use cannabis for symptom management. Because cannabis use increases the risk of cannabis use disorders (CUDs), we examined time trends in CUD among VHA patients with and without chronic pain, and whether these trends differed by age. From VHA electronic health records from 2005 to 2019 (∼4.3-5.6 million patients yearly), we extracted diagnoses of CUD and chronic pain conditions (International Classification of Diseases [ICD]-9-CM, 2005-2014; ICD-10-CM, 2016-2019). Differential trends in CUD prevalence overall and age-stratified (<35, 35-64, or ≥65) were assessed by any chronic pain and number of pain conditions (0, 1, or ≥2). From 2005 to 2014, the prevalence of CUD among patients with any chronic pain increased significantly more (1.11%-2.56%) than those without pain (0.70%-1.26%). Cannabis use disorder prevalence increased significantly more among patients with chronic pain across all age groups and was highest among those with ≥2 pain conditions. From 2016 to 2019, CUD prevalence among patients age ≥65 with chronic pain increased significantly more (0.63%-1.01%) than those without chronic pain (0.28%-0.47%) and was highest among those with ≥2 pain conditions. Over time, CUD prevalence has increased more among VHA patients with chronic pain than other VHA patients, with the highest increase among those age ≥65. Clinicians should monitor symptoms of CUD among VHA patients and others with chronic pain who use cannabis, and consider noncannabis therapies, particularly because the effectiveness of cannabis for chronic pain management remains inconclusive.
PMID: 37159542
ISSN: 1872-6623
CID: 5524522

Applications of agent-based modeling in trauma research

Tracy, Melissa; Gordis, Elana; Strully, Kate; Marshall, Brandon D L; Cerdá, Magdalena
Trauma, violence, and their consequences for population health are shaped by complex, intersecting forces across the life span. We aimed to illustrate the strengths of agent-based modeling (ABM), a computational approach in which population-level patterns emerge from the behaviors and interactions of simulated individuals, for advancing trauma research; Method: We provide an overview of agent-based modeling for trauma research, including a discussion of the model development process, ABM as a complement to other causal inference and complex systems approaches in trauma research, and past ABM applications in the trauma literature; Results: We use existing ABM applications to illustrate the strengths of ABM for trauma research, including incorporating interactions between individuals, simulating processes across multiple scales, examining life-course effects, testing alternate theories, comparing intervention strategies in a virtual laboratory, and guiding decision making. We also discuss the challenges of applying ABM to trauma research and offer specific suggestions for incorporating ABM into future studies of trauma and violence; Conclusion: Agent-based modeling is a useful complement to other methodological advances in trauma research. We recommend a more widespread adoption of ABM, particularly for research into patterns and consequences of individual traumatic experiences across the life course and understanding the effects of interventions that may be influenced by social norms and social network structures. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
PMCID:10030380
PMID: 36136775
ISSN: 1942-969x
CID: 5524472

State-Level History of Overdose Deaths Involving Stimulants in the United States, 1999‒2020

Kline, David; Bunting, Amanda M; Hepler, Staci A; Rivera-Aguirre, Ariadne; Krawczyk, Noa; Cerda, Magdalena
PMID: 37556789
ISSN: 1541-0048
CID: 5594992

Trends in Cannabis-positive Urine Toxicology Test Results: US Veterans Health Administration Emergency Department Patients, 2008 to 2019

Fink, David S; Malte, Carol; Cerdá, Magdalena; Mannes, Zachary L; Livne, Ofir; Martins, Silvia S; Keyhani, Salomeh; Olfson, Mark; McDowell, Yoanna; Gradus, Jaimie L; Wall, Melanie M; Sherman, Scott; Maynard, Charles C; Saxon, Andrew J; Hasin, Deborah S
OBJECTIVES/OBJECTIVE:This study aimed to examine trends in cannabis-positive urine drug screens (UDSs) among emergency department (ED) patients from 2008 to 2019 using data from the Veterans Health Administration (VHA) health care system, and whether these trends differed by age group (18-34, 35-64, and 65-75 years), sex, and race, and ethnicity. METHOD/METHODS:VHA electronic health records from 2008 to 2019 were used to identify the percentage of unique VHA patients seen each year at an ED, received a UDS, and screened positive for cannabis. Trends in cannabis-positive UDS were examined by age, race and ethnicity, and sex within age groups. RESULTS:Of the VHA ED patients with a UDS, the annual prevalence positive for cannabis increased from 16.42% in 2008 to 27.2% in 2019. The largest increases in cannabis-positive UDS were observed in the younger age groups. Male and female ED patients tested positive for cannabis at similar levels. Although the prevalence of cannabis-positive UDS was consistently highest among non-Hispanic Black patients, cannabis-positive UDS increased in all race and ethnicity groups. DISCUSSION/CONCLUSIONS:The increasing prevalence of cannabis-positive UDS supports the validity of previously observed population-level increases in cannabis use and cannabis use disorder from survey and administrative records. Time trends via UDS results provide additional support that previously documented increases in self-reported cannabis use and disorder from surveys and claims data are not spuriously due to changes in patient willingness to report use as it becomes more legalized, or due to greater clinical attention over time.
PMID: 37418654
ISSN: 1935-3227
CID: 5524562

Correction to: Scaling Interventions to Manage Chronic Disease: Innovative Methods at the Intersection of Health Policy Research and Implementation Science

McGinty, Emma E; Seewald, Nicholas J; Bandara, Sachini; Cerdá, Magdalena; Daumit, Gail L; Eisenberg, Matthew D; Griffin, Beth Ann; Igusa, Tak; Jackson, John W; Kennedy-Hendricks, Alene; Marsteller, Jill; Miech, Edward J; Purtle, Jonathan; Schmid, Ian; Schuler, Megan S; Yuan, Christina T; Stuart, Elizabeth A
PMID: 37395869
ISSN: 1573-6695
CID: 5524552

Changes in Opioid and Benzodiazepine Poisoning Deaths After Cannabis Legalization in the US: A County-level Analysis, 2002-2020

Castillo-Carniglia, Alvaro; Rivera-Aguirre, Ariadne; Santaella-Tenorio, Julian; Fink, David S; Crystal, Stephen; Ponicki, William; Gruenewald, Paul; Martins, Silvia S; Keyes, Katherine M; Cerdá, Magdalena
BACKGROUND:Cannabis legalization for medical and recreational purposes has been suggested as an effective strategy to reduce opioid and benzodiazepine use and deaths. We examined the county-level association between medical and recreational cannabis laws and poisoning deaths involving opioids and benzodiazepines in the US from 2002 to 2020. METHODS:Our ecologic county-level, spatiotemporal study comprised 49 states. Exposures were state-level implementation of medical and recreational cannabis laws and state-level initiation of cannabis dispensary sales. Our main outcomes were poisoning deaths involving any opioid, any benzodiazepine, and opioids with benzodiazepines. Secondary analyses included overdoses involving natural and semi-synthetic opioids, synthetic opioids, and heroin. RESULTS:Implementation of medical cannabis laws was associated with increased deaths involving opioids (rate ratio [RR] = 1.14; 95% credible interval [CrI] = 1.11, 1.18), benzodiazepines (RR = 1.19; 95% CrI = 1.12, 1.26), and opioids+benzodiazepines (RR = 1.22; 95% CrI = 1.15, 1.30). Medical cannabis legalizations allowing dispensaries was associated with fewer deaths involving opioids (RR = 0.88; 95% CrI = 0.85, 0.91) but not benzodiazepine deaths; results for recreational cannabis implementation and opioid deaths were similar (RR = 0.81; 95% CrI = 0.75, 0.88). Recreational cannabis laws allowing dispensary sales was associated with consistent reductions in opioid- (RR = 0.83; 95% CrI = 0.76, 0.91), benzodiazepine- (RR = 0.79; 95% CrI = 0.68, 0.92), and opioid+benzodiazepine-related poisonings (RR = 0.83; 95% CrI = 0.70, 0.98). CONCLUSIONS:Implementation of medical cannabis laws was associated with higher rates of opioid- and benzodiazepine-related deaths, whereas laws permitting broader cannabis access, including implementation of recreational cannabis laws and medical and recreational dispensaries, were associated with lower rates. The estimated effects of the expanded availability of cannabis seem dependent on the type of law implemented and its provisions.
PMID: 36943813
ISSN: 1531-5487
CID: 5524512