Some Emergency Departments See Drop in Heroin Overdoses

MedicalResearch.com Interview with:
<p style="font-size: 0.9rem;font-style: italic;"><a href="https://www.flickr.com/photos/35294562@N00/3049812708">"High School Photography"</a><span>by <a href="https://www.flickr.com/photos/35294562@N00">nadja.robot</a></span> is licensed under <a href="https://creativecommons.org/licenses/by-nc/2.0/?ref=ccsearch&atype=html" style="margin-right: 5px;">CC BY-NC 2.0</a><a href="https://creativecommons.org/licenses/by-nc/2.0/?ref=ccsearch&atype=html" target="_blank" rel="noopener noreferrer" style="display: inline-block;white-space: none;opacity: .7;margin-top: 2px;margin-left: 3px;height: 22px !important;"><img style="height: inherit;margin-right: 3px;display: inline-block;" src="https://ccsearch.creativecommons.org/static/img/cc_icon.svg" /><img style="height: inherit;margin-right: 3px;display: inline-block;" src="https://ccsearch.creativecommons.org/static/img/cc-by_icon.svg" /><img style="height: inherit;margin-right: 3px;display: inline-block;" src="https://ccsearch.creativecommons.org/static/img/cc-nc_icon.svg" /></a></p>Alana Vivolo-Kantor, PhD, MPH

Behavioral Scientist, Injury Center
CDC

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: This study analyzed emergency department (ED) data from 23 states funded by CDC’s Enhanced State Opioid Overdose Surveillance (ESOOS) program to understand changes in suspected heroin overdose from 2017 to 2018. Overall there was a significant yearly decrease of 21.5% in heroin overdose ED visits in the 23 ESOOS states.

  • Overall, the 23 ESOOS states saw a significant yearly decrease of 21.5% in heroin overdose emergency department visits.
  • Ten states witnessed significant yearly decreases ranging from 12.6% (Massachusetts) to 67.5% (District of Columbia).
  • Decreases occurred mostly in eastern states (District of Columbia, Kentucky, Maryland, Massachusetts, New Hampshire, Ohio, Pennsylvania, Rhode Island, West Virginia, and Wisconsin).
  • Three states witnessed significant yearly increases (Indiana, Illinois, and Utah).

MedicalResearch.com: What should readers take away from your report? 

  • Monitoring overdose fatalities is difficult as a result of time lags in reporting; however, emergency department (ED) data can be used to rapidly detect changes in overdose trends.
  • This study showcases the importance of using emergency department data as an early warning system for communities so that they can better monitor and respond to overdoses. 

MedicalResearch.com: What recommendations do you have for future research as a result of this work?

  • Public health agencies need support to develop rapid surveillance of local trends with a standardized national definition of suspected drug overdose, including heroin, that meets their needs
  • Real-time data on overdoses could be used to guide prevention initiatives, such as distributing naloxone, linking patients to peer navigators, and initiating medication-assisted treatment for opioid use disorder. 

MedicalResearch.com: Is there anything else you would like to add?

  • The findings in this report demonstrate the local and dynamic nature of this epidemic, and highlights the need for timely regional, state, and local information.
  • No disclosures.

Citation:

American Journal of Public Health (AJPH)
Suspected Heroin Overdoses in US Emergency Departments, 2017–2018

May 22, 2019 @ 12:08 am

 

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US Tops Opioids Deaths Among 13 High Income Countries

MedicalResearch.com Interview with:
"Drug Addiction" by Joana Faria is licensed under CC BY-NC-ND 4.0Yingxi (Cimo) Chen, MD, MPH, PhD
Postdoctoral Fellow
Radiation Epidemiology Branch, DCEG, NCI, NIH
Rockville MD 20850 

MedicalResearch.com: What is the background for this study?

Response: Death rates from drug overdose have more than doubled in the US in the 21st century. Similar increases in drug overdose deaths have been reported in other high-income countries but few studies have compared rates across countries.  Continue reading

Fentanyl Strips Can Prevent Opioid Overdoses

MedicalResearch.com Interview with:
"150826-fentanyl-factory-underground-illicit.jpg" by r. nial bradshaw is licensed under CC BY 2.0
Jon Zibbell, PhD,
Senior public health scientist
Behavioral Health Research Division
RTI International
Research Triangle Park, NC, 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: For the first time in 2016, U.S. overdose deaths involving illicitly-manufactured fentanyl surpassed deaths from heroin and prescription deaths.

Fentanyl is an extremely potent synthetic opioid, and an illicitly-manufactured form of the drug is regularly being mixed with heroin and often sold to unwitting consumers. Fentanyl is 50 times more potent than heroin and its illicitly-manufactured version is extremely difficult to discern when mixed with heroin. Harm reduction organizations have started to distribute FTS and people consuming street-purchased opioids are using them to test drugs for fentanyl. Our objective was to assess whether this point-of-use form of drug checking was influencing people’s drug use behavior. The study was self-funded by the research institute RTI International.

Our findings show that consumers who tested street opioids with fentanyl test strips were five times more likely to engage in safer drug use behavior when the test comes back positive. The study was conducted among a group of 125 people who inject drugs in Greensboro, North Carolina.

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Analyzing Street Drugs Can Provide Early Warning of Potential For Fatal Overdoses

MedicalResearch.com Interview with:
“MEXICO-DRUGS/” by Claudio Toledo is licensed under CC BY 2.0Kathleen Creppage, M.P.H., C.P.H.
Doctoral candidate Graduate School of Public Health
University of Pittsburgh

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: In the U.S., fatal heroin overdoses have increased in the past decade by 300 percent, with fentanyl – a substance that is 20 to 50 times more potent than heroin – and its analogs increasingly contributing to overdoses. The drug often is implicated in clusters of overdose deaths when it is mixed with heroin and users do not realize what they are taking is more powerful than usual.

We analyzed the test results of 16,594 stamp bags seized as evidence by law enforcement authorities in Allegheny County that were submitted to the county’s Office of the Medical Examiner for laboratory testing from 2010 through 2016. Stamp bags are small wax packets that contain mixtures of illicit drugs, most commonly heroin, packaged for sale and sometimes stamped with a graphical logo by drug dealers to market their contents.

Before 2014, none of the tested bags contained fentanyl. By 2016 it was found in 15.5 percent of the tested stamp bags, with 4.1 percent containing fentanyl as the only controlled substance present.

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Half Of People Who Died of Opioid Overdoses Tested Positive For Fentanyl

MedicalResearch.com Interview with:
“no drugs” by Anderson Mancini is licensed under CC BY 2.0
Julie K. O’Donnell, PhD
Division of Unintentional Injury Prevention
National Center for Injury Prevention and Control
CDC

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The opioid overdose epidemic has killed over 300,000 Americans from 1999 to 2015—including 33,091 in 2015. Over this time, the epidemic has evolved from being primarily driven by prescription opioids to increasingly being driven by illicit opioids. The first wave of the epidemic began in 1999 with a steep increase in deaths involving prescription opioids, such as hydrocodone, oxycodone, and morphine. The second wave began in 2010 with rapid increases in overdose deaths involving heroin. The third wave of the epidemic began in 2013, with significant increases in overdose deaths involving synthetic opioids—particularly those involving illicitly-manufactured fentanyl (IMF), which are commonly laced into heroin products. Most recently, the IMF market continues to evolve, with an ever-widening array of illicitly manufactured fentanyl analogs being distributed.

This report indicates that over half of people in 10 states who died of opioid overdoses tested positive for fentanyl during the second half of 2016. The report found that out of a total of 5,152 opioid overdose deaths, almost 3,000 tested positive for fentanyl, and over 700 tested positive for drugs that have similar chemical structures to fentanyl (fentanyl analogs) – including the extremely potent fentanyl analog, carfentanil, which is used to sedate large animals.

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Overdose Deaths Increase Across Urban Status, Sex and Race Lines

MedicalResearch.com Interview with:
“Pills” by Kurtis Garbutt is licensed under CC BY 2.0
Christopher M. Jones, PharmD
Office of the Assistant Secretary for Planning and Evaluation
Office of the Secretary
U.S. Department of Health and Human Services 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Drug overdoses are the leading cause of injury death in the United States, resulting in approximately 52,000 deaths in 2015. Although prescription drugs, in particular opioid pain relievers, were primarily responsible for the rapid expansion of this large and growing public health crisis, illicit drugs (heroin, illicit fentanyl, cocaine, and methamphetamines) now are contributing substantially to the problem. Understanding differences in illicit drug use, illicit drug use disorders, and overall drug overdose deaths in metropolitan and nonmetropolitan areas is important for informing public health programs, interventions, and policies.

We found that the prevalence of self-reported past-month use of illicit drugs increased significantly across urban status (large metropolitan, small metropolitan, and nonmetropolitan) between 2003-2005 and 2012-2014. Prevalence was higher for males than females, however, in the large metropolitan group, the percentage increase in prevalence from 2003–2005 to 2012–2014 was greater for females (23.4%) than for males (21.6%). There were notable differences by age. During 2012–2014, respondents aged 18–25 years had the highest prevalence of past-month use of illicit drugs for all urban levels. For respondents in this age group, the prevalence increased slightly from 2003–2005 to 2012–2014 in large metropolitan areas while the prevalence remained stable among small metropolitan area respondents and nonmetropolitan area respondents. Past-month use of illicit drugs declined over the study period for the youngest respondents (aged 12–17 years), with the largest decline among small metropolitan area youth.

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Managers Frequently Encounter Drug Use and Overdoses in Business Bathrooms

MedicalResearch.com Interview with:

Brett Wolfson-Stofko, PhD, Post-Doctoral Fellow Behavioral Science Training Program Center for Drug Use and HIV/HCV Research Rory Meyers College of Nursing New York University New York, NY 10003 Research Associate Institute for Special Populations National Development & Research Institutes, Inc.

Dr. Brett Wolfson-Stofko

Brett Wolfson-Stofko, PhD Post-Doctoral Fellow
Behavioral Science Training Program
Center for Drug Use and HIV/HCV Research
Rory Meyers College of Nursing
New York University New York, NY 10003
Research Associate Institute for Special Populations
National Development & Research Institutes, Inc.

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Drug overdose mortality rates per year continue to rise in the US. Previous research suggests that public bathrooms are among the most popular public injection locations for people who inject drugs (PWID) in New York City. Though syringe exchange programs provide sterile injection equipment they are not authorized to offer a safe and sanitary space for injection which leads many, particularly those that are unstably housed, to inject in public spaces. This study interviewed 86 business managers throughout NYC and 58% (n = 50) of these managers had encountered drug use in their business bathroom within the past 6 months. Over one-third found improperly disposed syringes and 14% encountered unresponsive individuals. Only 10% of managers reported some form of overdose recognition and naloxone training while 64% of managers thought overdose recognition and naloxone training would be useful for them and their staff.

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Multifactorial Causes For Increase In Overdoses From Opiod Painkillers

Nicholas B. King, PhD, Biomedical Ethics Unit McGill University Montreal QC CanadaMedicalResearch.com Interview with:
Nicholas B. King, PhD,
Biomedical Ethics Unit
McGill University
Montreal QC Canada

MedicalResearch: What are the main findings of the study?

Dr. King: Unintentional overdoses from prescription opioid painkillers have been rising sharply in the US and Canada during the past two decades, killing thousands of people every year. A lot has been written about the subject in both popular media and scholarly literature, but we still don’t have a very good idea of why this has happened. So we tried to objectively and systematically assess evidence for what has contributed to increasing mortality. We found the following:

(1) The evidence base for why mortality has increased is very thin, and more research is urgently required.

(2) We found evidence for at least 17 different causes of increased mortality. We found the most evidence for the following factors: dramatically increased prescription and sales of opioids; increased use of strong, long-acting opioids like oxycodone and methadone; combined use of opioids and other (licit and illicit) drugs and alcohol; and social and demographic characteristics. We found little evidence that internet sales of pharmaceuticals and errors by doctors and patients–factors commonly cited in the media–have played a significant role.

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