Touchpoints - Opportunities to predict and prevent opioid overdose: A cohort study.
Adolescent
Adult
Analgesics, Opioid
/ therapeutic use
Child
Criminal Law
/ statistics & numerical data
Drug Overdose
/ mortality
Drug Prescriptions
/ statistics & numerical data
Female
Forecasting
/ methods
Humans
Male
Massachusetts
/ epidemiology
Middle Aged
Opioid-Related Disorders
/ mortality
Patient Acceptance of Health Care
/ statistics & numerical data
Retrospective Studies
Risk
Young Adult
Opioid overdose
Opioid prescribing
Population attributable fraction
Standardized mortality ratio
Journal
Drug and alcohol dependence
ISSN: 1879-0046
Titre abrégé: Drug Alcohol Depend
Pays: Ireland
ID NLM: 7513587
Informations de publication
Date de publication:
01 11 2019
01 11 2019
Historique:
received:
05
03
2019
revised:
21
06
2019
accepted:
27
06
2019
pubmed:
16
9
2019
medline:
28
7
2020
entrez:
16
9
2019
Statut:
ppublish
Résumé
Medical care, public health, and criminal justice systems encounters could serve as touchpoints to identify and intervene with individuals at high-risk of opioid overdose death. The relative risk of opioid overdose death and proportion of deaths that could be averted at such touchpoints are unknown. We used 8 individually linked data sets from Massachusetts government agencies to perform a retrospective cohort study of Massachusetts residents ages 11 and older. For each month in 2014, we identified past 12-month exposure to 4 opioid prescription touchpoints (high dosage, benzodiazepine co-prescribing, multiple prescribers, or multiple pharmacies) and 4 critical encounter touchpoints (opioid detoxification, nonfatal opioid overdose, injection-related infection, and release from incarceration). The outcome was opioid overdose death. We calculated Standardized Mortality Ratios (SMRs) and Population Attributable Fractions (PAFs) associated with touchpoint exposure. The cohort consisted of 6,717,390 person-years of follow-up with 1315 opioid overdose deaths. We identified past 12-month exposure to any touchpoint in 2.7% of person-months and for 51.8% of opioid overdose deaths. Opioid overdose SMRs were 12.6 (95% CI: 11.1, 14.1) for opioid prescription and 68.4 (95% CI: 62.4, 74.5) for critical encounter touchpoints. Fatal opioid overdose PAFs were 0.19 (95% CI: 0.17, 0.21) for opioid prescription and 0.37 (95% CI: 0.34, 0.39) for critical encounter touchpoints. Using public health data, we found eight candidate touchpoints were associated with increased risk of fatal opioid overdose, and collectively identified more than half of opioid overdose decedents. These touchpoints are potential targets for development of overdose prevention interventions.
Sections du résumé
BACKGROUND
Medical care, public health, and criminal justice systems encounters could serve as touchpoints to identify and intervene with individuals at high-risk of opioid overdose death. The relative risk of opioid overdose death and proportion of deaths that could be averted at such touchpoints are unknown.
METHODS
We used 8 individually linked data sets from Massachusetts government agencies to perform a retrospective cohort study of Massachusetts residents ages 11 and older. For each month in 2014, we identified past 12-month exposure to 4 opioid prescription touchpoints (high dosage, benzodiazepine co-prescribing, multiple prescribers, or multiple pharmacies) and 4 critical encounter touchpoints (opioid detoxification, nonfatal opioid overdose, injection-related infection, and release from incarceration). The outcome was opioid overdose death. We calculated Standardized Mortality Ratios (SMRs) and Population Attributable Fractions (PAFs) associated with touchpoint exposure.
RESULTS
The cohort consisted of 6,717,390 person-years of follow-up with 1315 opioid overdose deaths. We identified past 12-month exposure to any touchpoint in 2.7% of person-months and for 51.8% of opioid overdose deaths. Opioid overdose SMRs were 12.6 (95% CI: 11.1, 14.1) for opioid prescription and 68.4 (95% CI: 62.4, 74.5) for critical encounter touchpoints. Fatal opioid overdose PAFs were 0.19 (95% CI: 0.17, 0.21) for opioid prescription and 0.37 (95% CI: 0.34, 0.39) for critical encounter touchpoints.
CONCLUSIONS
Using public health data, we found eight candidate touchpoints were associated with increased risk of fatal opioid overdose, and collectively identified more than half of opioid overdose decedents. These touchpoints are potential targets for development of overdose prevention interventions.
Identifiants
pubmed: 31521956
pii: S0376-8716(19)30296-0
doi: 10.1016/j.drugalcdep.2019.06.039
pmc: PMC7020606
mid: NIHMS1545406
pii:
doi:
Substances chimiques
Analgesics, Opioid
0
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
107537Subventions
Organisme : NIDA NIH HHS
ID : K23 DA042168
Pays : United States
Informations de copyright
Copyright © 2019 Elsevier B.V. All rights reserved.
Références
Prev Med. 2018 Jul;112:176-178
pubmed: 29684417
J Gen Intern Med. 2017 Jun;32(6):660-666
pubmed: 28194688
JAMA. 2016 Apr 19;315(15):1624-45
pubmed: 26977696
Med Care. 2018 Oct;56(10):e70-e75
pubmed: 29200131
Med Care. 2017 Jul;55(7):661-668
pubmed: 28614178
J Subst Abuse Treat. 2015 Dec;59:99-103
pubmed: 26254317
J Subst Abuse Treat. 2016 Jul;66:48-53
pubmed: 27211996
JAMA Intern Med. 2014 May;174(5):802-3
pubmed: 24589763
JAMA. 2015 Apr 28;313(16):1636-44
pubmed: 25919527
Inj Epidemiol. 2019 Jan 21;6(1):2
pubmed: 30663005
Pharmacoepidemiol Drug Saf. 2017 May;26(5):509-517
pubmed: 28074520
JAMA Psychiatry. 2018 Aug 1;75(8):820-827
pubmed: 29926090
Subst Abuse Rehabil. 2017 Aug 16;8:57-67
pubmed: 28860892
BMJ. 2018 Aug 1;362:k2833
pubmed: 30068513
JAMA. 2015 Mar 3;313(9):891-2
pubmed: 25622279
Ann Epidemiol. 2015 Aug;25(8):613-619.e2
pubmed: 25935710
Am J Med. 2016 May;129(5):481-5
pubmed: 26597670
Int J Drug Policy. 2017 Aug;46:112-119
pubmed: 28688539
Int J Drug Policy. 2018 Apr;54:43-50
pubmed: 29414484
Addict Sci Clin Pract. 2019 Feb 19;14(1):5
pubmed: 30777122
JAMA Psychiatry. 2018 Apr 1;75(4):405-407
pubmed: 29450443
JAMA Intern Med. 2014 May;174(5):796-801
pubmed: 24589873
N Engl J Med. 2007 Jan 11;356(2):157-65
pubmed: 17215533
J Thorac Cardiovasc Surg. 2016 Sep;152(3):832-841.e1
pubmed: 27068439
Subst Abus. 2017 Oct-Dec;38(4):389-393
pubmed: 28692407
Ann Intern Med. 2017 Aug 1;167(3):181-191
pubmed: 28715848
Health Aff (Millwood). 2016 May 1;35(5):832-7
pubmed: 27140989
MMWR Morb Mortal Wkly Rep. 2016 Dec 30;65(50-51):1445-1452
pubmed: 28033313
J Subst Abuse Treat. 2013 Sep;45(3):302-5
pubmed: 23786852
Addiction. 2016 Jul;111(7):1177-87
pubmed: 27028542
Addiction. 2010 Sep;105(9):1545-54
pubmed: 20579009
Drug Alcohol Depend. 2016 May 1;162:51-5
pubmed: 26993373
Ann Intern Med. 2010 Jan 19;152(2):85-92
pubmed: 20083827
MMWR Morb Mortal Wkly Rep. 2017 Sep 01;66(34):897-903
pubmed: 28859052
BMJ. 2017 Apr 26;357:j1550
pubmed: 28446428
Ann Intern Med. 2018 Aug 7;169(3):137-145
pubmed: 29913516
MMWR Morb Mortal Wkly Rep. 2017 Jul 07;66(26):697-704
pubmed: 28683056
Addiction. 2007 Dec;102(12):1954-9
pubmed: 18031430
West J Emerg Med. 2015 May;16(3):381-4
pubmed: 25987910
J Addict Med. 2019 Mar/Apr;13(2):104-112
pubmed: 30608266
JAMA Intern Med. 2014 Aug;174(8):1369-76
pubmed: 25090173
JAMA. 2011 Apr 6;305(13):1315-21
pubmed: 21467284
MMWR Morb Mortal Wkly Rep. 2017 Apr 14;66(14):382-386
pubmed: 28406883
BMJ. 2015 Jun 10;350:h2698
pubmed: 26063215
BMJ. 2013 Jan 30;346:f174
pubmed: 23372174
J Gen Intern Med. 2018 Sep;33(9):1512-1519
pubmed: 29948815
Inj Prev. 2018 Feb;24(1):48-54
pubmed: 28835443
Drug Alcohol Depend. 2011 Jun 1;115(3):190-5
pubmed: 21130585
J Subst Abuse Treat. 2017 Aug;79:1-5
pubmed: 28673521
Ann Intern Med. 2013 Nov 5;159(9):592-600
pubmed: 24189594