Living Alone and Drug Overdose Deaths in the US.
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ABSTRACT:
SUBMITTER: Olfson M
PROVIDER: S-EPMC10099087 | biostudies-literature | 2023 Jun
REPOSITORIES: biostudies-literature
Publications
Living Alone and Drug Overdose Deaths in the US.
Olfson Mark M Cosgrove Candace M CM Wall Melanie M MM Blanco Carlos C
JAMA psychiatry 20230601 6
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Project description:ImportanceMedicaid programs have expanded coverage of substance use disorder treatment and undertaken many other initiatives to reduce drug overdoses among beneficiaries. However, to date, no information has been published that tracks overdose deaths among the Medicaid population.ObjectiveTo determine the rate of drug overdose among Medicaid beneficiaries.Design, setting, and participantsIn this cross-sectional study, US Centers for Medicare & Medicaid Services data from 2016 to 2020 that linked enrollment and demographic data from all Medicaid beneficiaries in the US with the US Centers for Disease Control and Prevention National Death Index were used to determine the rate of drug overdose death among Medicaid beneficiaries. The Medicaid population rates were compared with those of the total US population, overall and by age and sex.ExposureParticipation in the Medicaid program.Main outcomeDeath of a drug overdose.ResultsIn 2020, the drug overdose death rate among Medicaid beneficiaries was 54.6 per 100 000, a rate that was twice as high as the drug overdose rate among all US residents (27.9 per 100 000). In 2020, Medicaid beneficiaries comprised 25.0% of the US population but 48% of all overdose deaths (44 277 of 91 783). For each age and sex group older than 15 years, overdose deaths were higher for the Medicaid population than for the US population, with the greatest difference occurring among adults ages 45 to 64 years. From 2016 to 2020, Medicaid overdose deaths increased by 54%.Conclusions and relevanceThe results of this study suggest that more research is needed to understand why Medicaid beneficiaries have higher rates of drug overdoses than all US residents. Additionally, research is needed to understand how best to prevent overdoses among Medicaid beneficiaries. The federal government should support these efforts by routinely linking Medicaid claims and enrollment data to death records.
| S-EPMC11624576 | biostudies-literature
Project description:BackgroundOverdose deaths increased exponentially in the United States to be the leading cause of adult injury deaths, and declining economic opportunity may contribute. To our knowledge, there has been no quantitative research into the impact of relative economic measures on overdose risk. Prior longitudinal studies on impact of socioeconomic conditions used fixed effects approaches that can result in biased estimates in the presence of time-varying confounders.MethodsWe estimated county-level longitudinal associations between drug overdose deaths and unemployment and labor-force nonparticipation rates by gender and racial/ethnic subgroup using longitudinal g-computation and the clustered bootstrap.ResultsWe find evidence for associations between both overall and relative aspects of unemployment and labor-force nonparticipation and drug overdose mortality; patterns of associations differed, sometime qualitatively, across subgroups. For males across racial-ethnic groups, greater overall and relative unemployment rates were generally associated with greater overdose mortality in both the short and long terms [e.g., for white males, increasing the overall percentage of unemployed adults by 5% points in 2000, 2009, and 2015 is associated with an increase of 3.2 overdose deaths (95% confidence interval [CI] = -2.8, 14) in 2015, and increasing the ratio by 0.5 in 2000, 2009, and 2015 is associated with an increase of 9.1 overdose deaths (95% CI = 1.6, 24)].ConclusionsThese findings point to important complexity in how the economic and contextual landscape differentially shapes overdose risks, underscoring a need for increased understanding of the mechanisms operating for women and minority groups.
| S-EPMC7505523 | biostudies-literature
Project description:ImportanceEducational attainment in the US is associated with life expectancy. As the opioid crisis worsens, it is critical to understand how overdose death rate trends evolve across education groups.ObjectiveTo investigate the association between educational attainment and overdose death rates, with emphasis on trends during the COVID-19 pandemic.Design, setting, and participantsThis cross-sectional study used National Vital Statistics System Mortality Multiple Cause-of-Death data describing overdose death rates in the US by educational attainment from January 1, 2000, to December 31, 2021, with a focus on 2018 to 2021. Overdose deaths were aggregated by year and educational level for decedents aged 25 years or older.ExposureEducational attainment, categorized as no high school (HS) diploma, HS diploma (or General Educational Development) but no college, some college but no bachelor's degree, and bachelor's degree or more.Main outcomes and measuresThe main outcomes were rates of all overdose deaths, overdose deaths involving opioids, and overdose deaths involving synthetic opioids.ResultsOf 912 057 overdose deaths with education information from 2000 to 2021 (mean [SD] age at death, 44.9 [12.3] years; 64.1% male), there were 625 400 deaths (68.6%) among individuals with no college education and 286 657 deaths (31.4%) among those with at least some college. The overdose death rate was 19.9 per 100 000 population. From 2018 to 2021, there were 301 557 overdose deaths, including 58 319 (19.3%) among individuals without an HS diploma, 153 603 (50.9%) among people with an HS diploma, 64 682 (21.4%) among individuals with some college, and 24 953 (8.3%) among individuals with a bachelor's degree. There were 3324 overdose deaths (1.1%) among American Indian or Alaska Native individuals, 2968 (1.0%) among Asian American or Pacific Islander individuals, 49 152 (16.3%) among Black individuals, 31 703 (10.5%) among Hispanic individuals, 211 359 (70.1%) among White individuals, and 3051 (1.0%) among multiracial individuals. From 2018 to 2021, the overdose death rate was 33.4 per 100 000 population, the opioid-related overdose death rate was 24.2 per 100 000 population, and the synthetic opioid overdose death rate was 19.1 per 100 000 population. From 2018 to 2021, the overdose death rate for those without a HS diploma increased by 35.4 per 100 000 population compared with 1.5 per 100 000 population for those with a bachelor's degree. This differential growth was primarily due to increased rates of death involving synthetic opioids.Conclusions and relevanceIn this cross-sectional study, lower educational attainment was found to be associated with higher growth in overdose deaths. As the opioid crisis has transitioned to fentanyl and polysubstance use, overdose deaths have become more prevalent in groups with lower socioeconomic status, potentially exacerbating existing life-expectancy disparities.
| S-EPMC10559184 | biostudies-literature
Project description:ObjectiveTo examine the effects of a harm reduction policy, specifically Good Samaritan (GS) policy, on overdose deaths.Data sources/study settingSecondary data from multiple cause of death, mortality records paired with state harm reduction and substance use prevention policy.Study designWe estimate fixed effects Poisson count models to model the effect of GS policy on overdose deaths for all, prescription, and illicit drugs, controlled substances, and opioids, while controlling for other harm reduction and substance use prevention policies.Data collection/extraction methodsWe merge secondary data sources by state and year between 1999 and 2016.Principal findingsWe fail to identify a statistically significant effect of GS policy in reducing overdose deaths broadly.ConclusionsWhile we are unable to identify an effect of GS policy on overdose deaths, GS policy may have important effects on first-stage outcomes not investigated in this paper. Given recent state policy changes and rapid increase in many categories of overdose deaths, additional research should continue to examine the implementation and effects of harm reduction policy specifically and substance use prevention policy broadly.
| S-EPMC6407344 | biostudies-literature
Project description:IntroductionPrescription Drug Monitoring Program data can provide insights into a patient's likelihood of an opioid overdose, yet clinicians and public health officials lack indicators to identify individuals at highest risk accurately. A predictive model was developed and validated using Prescription Drug Monitoring Program prescription histories to identify those at risk for fatal overdose because of any opioid or illicit opioids.MethodsFrom December 2018 to July 2019, a retrospective cohort analysis was performed on Maryland residents aged 18-80 years with a filled opioid prescription (n=565,175) from January to June 2016. Fatal opioid overdoses were identified from the Office of the Chief Medical Examiner and were linked at the person-level with Prescription Drug Monitoring Program data. Split-half technique was used to develop and validate a multivariate logistic regression with a 6-month lookback period and assessed model calibration and discrimination.ResultsPredictors of any opioid-related fatal overdose included male sex, age 65-80 years, Medicaid, Medicare, 1 or more long-acting opioid fills, 1 or more buprenorphine fills, 2 to 3 and 4 or more short-acting schedule II opioid fills, opioid days' supply ≥91 days, average morphine milligram equivalent daily dose, 2 or more benzodiazepine fills, and 1 or more muscle relaxant fills. Model discrimination for the validation cohort was good (area under the curve: any, 0.81; illicit, 0.77).ConclusionsA model for predicting fatal opioid overdoses was developed using Prescription Drug Monitoring Program data. Given the recent national epidemic of deaths involving heroin and fentanyl, it is noteworthy that the model performed equally well in identifying those at risk for overdose deaths from both illicit and prescription opioids.
| S-EPMC7996003 | biostudies-literature
Project description:Background and aimsIn the US, benzodiazepine overdose deaths increased at an alarming rate in the past two decades. Benzodiazepines were also the most common drugs involved in prescription opioid overdose deaths. Benzodiazepine prescribing has been monitored by Prescription Drug Monitoring Programs (PDMPs), but little was known about whether PDMPs reduced drug overdose deaths involving benzodiazepines.Design and methodsThis study used a difference-in-difference design with state-quarter aggregate data on drug overdose deaths. The primary data source was Mortality Multiple Cause Files in 1999-2016. Three age-adjusted rates of drug overdose deaths were examined, including those involving benzodiazepines, those involving prescription opioids, and those involving both benzodiazepines and prescription opioids. The policy variables included PDMP data access for benzodiazepines and mandatory use of PDMP data for benzodiazepines. Linear multivariable regressions were used to assess the associations of PDMP policies specific to benzodiazepines with drug overdose death rates, controlling for other state-level policy and socioeconomic factors, state and time fixed effects, and state-specific time trends.ResultsNo significant associations were found between PDMP data access for benzodiazepines and changes in drug overdose death rates involving benzodiazepines and/or prescription opioids. Similarly, no significant associations were found between mandatory use of PDMP data for benzodiazepines and changes in drug overdose death outcomes.Discussion and conclusionsThis study suggested no evidence that PDMP policies specific to benzodiazepines were associated with reduction in benzodiazepine overdose death rates. Future research is warranted to examine detailed features of PDMPs and continuously monitor the impacts of PDMP policies on benzodiazepine-related consequences.
| S-EPMC6641857 | biostudies-literature
Project description: Not available
| S-EPMC9006103 | biostudies-literature
Project description:ImportanceXylazine is increasingly reported in street drugs and fatal overdoses in the US, yet state-level data are limited, hampering local public health responses.ObjectiveTo gather available state-level data on xylazine involvement in overdose deaths and in forensic drug reports.Design, setting, and participantsThis cross-sectional study was a secondary analysis of 2019 to 2022 data from the National Forensic Laboratory Information System (NFLIS), National Center for Health Statistics, and individual states' medical examiner or public health agency reports. Data were analyzed from August to October 2023.ExposureState.Main outcomes and measuresYearly xylazine-related overdose deaths per 100 000 residents; xylazine NFLIS drug reports, both per 100 000 residents and as a percentage of all NFLIS drug reports (from samples of drugs seized by law enforcement and analyzed by NFLIS-participating laboratories).ResultsA total of 63 state-years were included in analyses of mortality rates, while 204 state-years were included in analyses of NFLIS reports. According to the publicly available data compiled in this study, at least 43 states reported at least 1 xylazine-related overdose death from 2019 to 2022, yet yearly totals of xylazine-related deaths were available for only 21 states. Of states with data available, xylazine-involved overdose death rates were highest in Vermont (10.5 per 100 000 residents) and Connecticut (9.8 per 100 000 residents) in 2022. In 2019, 16 states had zero xylazine reports included in NFLIS reports; in 2022, only 2 states had zero xylazine reports and all but 3 states had recorded an increase in xylazine's representation in NFLIS reports. In 2022, xylazine represented 16.17% of all NFLIS reports in Delaware and between 5.95% and 7.00% of NFLIS reports in Connecticut, Maryland, District of Columbia, New Jersey, and Rhode Island, yet less than 1.0% of NFLIS reports in 35 different states.Conclusions and relevanceIn this cross-sectional study of publicly available data on fatal overdoses and drugs analyzed by forensic laboratories, xylazine's reported presence in overdose deaths and forensic reports was concentrated in the eastern US yet extended across the country to encompass nearly all states. In spite of xylazine's geographic reach, yearly state-level numbers of xylazine-related overdose deaths were publicly available for less than half of all states.
| S-EPMC10770774 | biostudies-literature
Project description: Not available
| S-EPMC10388669 | biostudies-literature
Project description:BackgroundAlcohol-involved overdose deaths are increasing and often occur with other substances but have been minimally studied compared to other causes of overdose.MethodsWe used national Veterans Health Administration (VHA) records linked to National Death Index data from 2012 to 2018 to examine trends in alcohol-related overdose mortality. Patient characteristics and treatment receipt were compared across categories of alcohol overdose deaths (alcohol-only, alcohol+opioids which may include additional substances, and alcohol+other substances without opioids).ResultsFrom 2012-2018, 2421 Veterans died from an alcohol-involved overdose (alcohol-only: 868, alcohol+opioids: 1269, alcohol+other substances: 284). The alcohol-involved overdose rate increased 57% during this period. Compared to those who died of an alcohol-only overdose, Veterans who died from alcohol+opioids and alcohol+other substances were more likely Black or Hispanic, and to have an opioid use disorder, but less likely to live in rural areas or to be diagnosed with alcohol use disorder (AUD). Only 32.5% of those who died from alcohol-involved overdose received treatment in a substance use disorder clinic in the year preceding death, compared to 65.1% seen in mental health and 85.7% in primary care. Only 9.5% of Veterans who died from alcohol overdose received medication treatment for AUD and 24.8% received psychotherapy for AUD in the year preceding death.ConclusionsAlcohol overdose is increasing primarily related to overdoses involving opioids and other substances. Most patients did not receive any effective medication or psychotherapy treatments for AUD, suggesting further need to identify those at risk and to target treatment for this vulnerable group in healthcare settings.
| S-EPMC8714700 | biostudies-literature