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Sean Hennessy - One of the best experts on this subject based on the ideXlab platform.
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incidence rates of and risk factors for Opioid Overdose in new users of prescription Opioids among us medicaid enrollees a cohort study
Pharmacoepidemiology and Drug Safety, 2020Co-Authors: Warren B Bilker, Francesco J Demayo, Mark D Neuman, Sean HennessyAbstract:PURPOSE To measure incidence rates of and risk factors for Opioid Overdose among new users of prescription Opioids in the Medicaid population. METHODS A cohort study using Medicaid claims from four states (1999-2012) among adults continuously enrolled in Medicaid for ≥3 years free of Opioid prescriptions and Opioid Overdose before cohort entry. Exposure and outcome of interest were prescription Opioid use and apparent incident Opioid Overdose identified in inpatient and outpatient claims (sensitivity ≈ 97%; positive predictive value ≈ 87%), respectively. RESULTS Among new prescription Opioid users (1 336 140 persons; 246 466 person-years), the overall Opioid Overdose incidence rate per 100 000 person-years was 247.1 (95% confidence interval [CI], 227.5-266.7), with 251.0 (CI, 188.6-313.5) in 2002 and 225.5 (CI, 142.0-309.0) in 2012. A lower hazard for Opioid Overdose was seen for age 65-80 years (adjusted hazard ratio [HR], 0.50; CI, 0.37-0.66) and 80-100 years (0.35; 0.23-0.52) vs 18-35 years; females (0.79; 0.67-0.93) vs males; and other/unknown race/ethnicity (0.71; 0.54-0.93) vs whites. A higher hazard was seen for initial Opioid dose in morphine milligram equivalents (MMEs), 50-100 MME/day (1.52; 1.24-1.86) and >100 MME/day (1.98; 1.55-2.53), vs <50 MME/day; prior diagnosis of substance use disorders (2.30; 1.91-2.79) or mental health conditions (1.75; 1.47-2.08); and prior prescriptions for benzodiazepines (1.43; 1.13-1.81). CONCLUSION In Medicaid enrollees in four study states during 2002 to 2012, Opioid Overdose incidence rate per 100 000 person-years among apparent new users of prescription Opioids was 247.1, with 251.0 in 2002 and 225.5 in 2012. Younger ages, white race/ethnicity, higher MME Opioid daily doses, prior substance use disorders, mental health conditions, and benzodiazepine prescriptions were associated with a higher risk of Opioid Overdose incidence.
Warren B Bilker - One of the best experts on this subject based on the ideXlab platform.
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incidence rates of and risk factors for Opioid Overdose in new users of prescription Opioids among us medicaid enrollees a cohort study
Pharmacoepidemiology and Drug Safety, 2020Co-Authors: Warren B Bilker, Francesco J Demayo, Mark D Neuman, Sean HennessyAbstract:PURPOSE To measure incidence rates of and risk factors for Opioid Overdose among new users of prescription Opioids in the Medicaid population. METHODS A cohort study using Medicaid claims from four states (1999-2012) among adults continuously enrolled in Medicaid for ≥3 years free of Opioid prescriptions and Opioid Overdose before cohort entry. Exposure and outcome of interest were prescription Opioid use and apparent incident Opioid Overdose identified in inpatient and outpatient claims (sensitivity ≈ 97%; positive predictive value ≈ 87%), respectively. RESULTS Among new prescription Opioid users (1 336 140 persons; 246 466 person-years), the overall Opioid Overdose incidence rate per 100 000 person-years was 247.1 (95% confidence interval [CI], 227.5-266.7), with 251.0 (CI, 188.6-313.5) in 2002 and 225.5 (CI, 142.0-309.0) in 2012. A lower hazard for Opioid Overdose was seen for age 65-80 years (adjusted hazard ratio [HR], 0.50; CI, 0.37-0.66) and 80-100 years (0.35; 0.23-0.52) vs 18-35 years; females (0.79; 0.67-0.93) vs males; and other/unknown race/ethnicity (0.71; 0.54-0.93) vs whites. A higher hazard was seen for initial Opioid dose in morphine milligram equivalents (MMEs), 50-100 MME/day (1.52; 1.24-1.86) and >100 MME/day (1.98; 1.55-2.53), vs <50 MME/day; prior diagnosis of substance use disorders (2.30; 1.91-2.79) or mental health conditions (1.75; 1.47-2.08); and prior prescriptions for benzodiazepines (1.43; 1.13-1.81). CONCLUSION In Medicaid enrollees in four study states during 2002 to 2012, Opioid Overdose incidence rate per 100 000 person-years among apparent new users of prescription Opioids was 247.1, with 251.0 in 2002 and 225.5 in 2012. Younger ages, white race/ethnicity, higher MME Opioid daily doses, prior substance use disorders, mental health conditions, and benzodiazepine prescriptions were associated with a higher risk of Opioid Overdose incidence.
Carlos A Camargo - One of the best experts on this subject based on the ideXlab platform.
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trends in u s emergency department visits for Opioid Overdose 1993 2010
Pain Medicine, 2014Co-Authors: Kohei Hasegawa, Janice A Espinola, David F M Brown, Carlos A CamargoAbstract:OBJECTIVE: Emergency department (ED) visits for Opioid Overdose provide an important marker of acute morbidity. We sought to evaluate national trends of ED visits for Opioid Overdose. DESIGN, SETTING, AND PARTICIPANTS: The National Hospital Ambulatory Medical Care Survey, 1993-2010, was used to identify ED visits for Opioid Overdose. OUTCOME MEASURES: Outcome measures were national ED visit rates for Opioid Overdose per 100,000 U.S. population and per 100,000 ED visits. RESULTS: From 1993 to 2010, there were approximately 731,000 ED visits (95% CI, 586,000-877,000 visits) for Opioid Overdose, representing an overall rate of 14 ED visits (95% CI, 12-17 visits) per 100,000 population and 37 ED visits (95% CI, 31-45 visits) per 100,000 ED visits. Of these, 41% (95% CI, 33-50%) were for prescription Opioid Overdose. Between 1993 and 2010, the national visit rate increased from 7 to 27 per 100,000 population (+307%; Ptrend = 0.03), and from 19 to 63 per 100,000 ED visits (+235%; Ptrend CONCLUSION: In a nationally representative database of U.S. ED visits, we found that the ED visit rate for Opioid Overdose quadrupled from 1993 to 2010. Our findings suggest that previous prevention measures may not be adequate. Language: en
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epidemiology of emergency department visits for Opioid Overdose a population based study
Mayo Clinic Proceedings, 2014Co-Authors: Kohei Hasegawa, David F M Brown, Yusuke Tsugawa, Carlos A CamargoAbstract:Abstract Objectives To evaluate the rate of emergency department (ED) visits for Opioid Overdose and to examine whether frequent ED visits for Opioid Overdose are associated with more hospitalizations, near-fatal events, and health care spending. Patients and Methods Retrospective cohort study of adults with at least 1 ED visit for Opioid Overdose between January 1, 2010, and December 31, 2011, derived from population-based data of State Emergency Department Databases and State Inpatient Databases for 2 large and diverse states: California and Florida. Main outcome measures were hospitalizations for Opioid Overdose, near-fatal events (Overdose involving mechanical ventilation), and hospital charges during the year after the first ED visit. Results The analytic cohort comprised 19,831 unique patients with 21,609 ED visits for Opioid Overdose. During a 1-year period, 7% (95% CI, 7%-7%; n=1389 patients) of the patients had frequent (2 or more) ED visits, accounting for 15% (95% CI, 14%-15%; n=3167) of all Opioid Overdose ED visits. Middle age, male sex, public insurance, lower household income, and comorbidities (such as chronic pulmonary disease and neurological diseases) were associated with frequent ED visits (all P Conclusion In this population-based cohort, we found that frequent ED visits for Opioid Overdose were associated with a higher likelihood of future hospitalizations and near-fatal events.
Jeremiah D Schuur - One of the best experts on this subject based on the ideXlab platform.
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One year mortality of patients treated with naloxone for Opioid Overdose by emergency medical services.
Substance Abuse, 2020Co-Authors: Mph Scott G. Weiner, Olesya Baker, Mph Dana Bernson, Jeremiah D SchuurAbstract:Study objective: Prehospital use of naloxone for presumed Opioid Overdose has increased markedly in recent years because of the current Opioid Overdose epidemic. In this study, we determine the 1-y...
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one year mortality of patients after emergency department treatment for nonfatal Opioid Overdose
Annals of Emergency Medicine, 2020Co-Authors: Scott G Weiner, Dana Bernson, Olesya Baker, Jeremiah D SchuurAbstract:Study objective Despite the increased availability of naloxone, death rates from Opioid Overdose continue to increase. The goal of this study is to determine the 1-year mortality of patients who were treated for a nonfatal Opioid Overdose in Massachusetts emergency departments (EDs). Methods This was a retrospective observational study of patients from 3 linked statewide Massachusetts data sets: a master demographics list, an acute care hospital case-mix database, and death records. Patients discharged from the ED with a final diagnosis of Opioid Overdose were included. The primary outcome measure was death from any cause within 1 year of Overdose treatment. Results During the study period, 17,241 patients were treated for Opioid Overdose. Of the 11,557 patients who met study criteria, 635 (5.5%) died within 1 year, 130 (1.1%) died within 1 month, and 29 (0.25%) died within 2 days. Of the 635 deaths at 1 year, 130 (20.5%) occurred within 1 month and 29 (4.6%) occurred within 2 days. Conclusion The short-term and 1-year mortality of patients treated in the ED for nonfatal Opioid Overdose is high. The first month, and particularly the first 2 days after Overdose, is the highest-risk period. Patients who survive Opioid Overdose should be considered high risk and receive interventions such as being offered buprenorphine, counseling, and referral to treatment before ED discharge.
Amy S.b. Bohnert - One of the best experts on this subject based on the ideXlab platform.
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association of Opioid Overdose risk factors and naloxone prescribing in us adults
Journal of General Internal Medicine, 2020Co-Authors: Chad M Brummett, Jennifer F Waljee, Michael J Englesbe, Vidhya Gunaseelan, Amy S.b. BohnertAbstract:Prescribing naloxone to patients is a key strategy to prevent Opioid Overdoses, but little is known about the reach of naloxone prescribing. Determine patient factors associated with receiving naloxone and trends over time in patients with key Overdose risk factors. Retrospective observational study. Using the Clinformatics DataMart, a US-wide health insurance claims dataset, we compared adults who received Opioids and naloxone (Opioid+naloxone) from January 2014 to June 2017 with adults who received Opioids without naloxone (Opioids only), matched on gender, age ± 5 years, month/year of Opioid fill, and number of Opioid claims. Key patient-level Opioid Overdose risk factors included receipt of high-dosage Opioids, concurrent benzodiazepines, history of Opioid and other substance use disorders, and history of Opioid Overdose. We included 3963 Opioid+naloxone and 19,815 Opioid only patients. Key factors associated with naloxone fills included high Opioid daily dosage (50 to < 90 morphine milligram equivalents (MME): AOR = 2.43, 95% CI 2.15–2.76 and ≥ 90 MME: AOR = 3.94, 95% CI 3.47–4.46; reference: < 50 MME), receiving concurrent benzodiazepines (AOR = 1.27, 95% CI 1.16–1.38), and having a diagnosis of Opioid use disorder (AOR = 1.56, 95% CI 1.40–1.73). History of Opioid Overdose was not associated with naloxone (AOR = 0.92, 95% CI 0.74–1.15). The percent of patients receiving naloxone increased, yet less than 2% of patients in any of the key Overdose risk factor groups received naloxone by the last 6 months of the study period. Naloxone prescribing has increased and was more likely to be co-prescribed to patients with some risk factors for Overdose. However, overall prescribing remains minimal. Additional efforts are needed across health systems to increase naloxone prescribing for patients at risk for Opioid Overdose.
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characteristics of us counties with high Opioid Overdose mortality and low capacity to deliver medications for Opioid use disorder
JAMA network open, 2019Co-Authors: Rebecca L Haffajee, Amy S.b. Bohnert, Jason E GoldstickAbstract:Importance Opioid Overdose deaths in the United States continue to increase, reflecting a growing need to treat those with Opioid use disorder (OUD). Little is known about counties with high rates of Opioid Overdose mortality but low availability of OUD treatment. Objective To identify characteristics of US counties with persistently high rates of Opioid Overdose mortality and low capacity to deliver OUD medications. Design, Setting, and Participants In this cross-sectional study of data from 3142 US counties from January 1, 2015, to December 31, 2017, rates of Opioid Overdose mortality were compared with availability in 2017 of OUD medication providers (24 851 buprenorphine-waivered clinicians [physicians, nurse practitioners, and physician assistants], 1517 Opioid treatment programs [providing methadone], and 5222 health care professionals who could prescribe extended-release naltrexone). Statistical analysis was performed from April 20, 2018, to May 8, 2019. Exposures Demographic, workforce, lack of insurance, road density, urbanicity, Opioid prescribing, and regional division county-level characteristics. Main Outcome and Measures The outcome variable, “Opioid high-risk county,” was a binary indicator of a high (above national) rate of Opioid Overdose mortality with a low (below national) rate of provider availability to deliver OUD medication. Spatial logistic regression models were used to determine associations with being an Opioid high-risk county. Results Of 3142 counties, 751 (23.9%) had high rates of Opioid Overdose mortality. A total of 1457 counties (46.4%), and 946 of 1328 rural counties (71.2%), lacked a publicly available OUD medication provider in 2017. In adjusted models, compared with the West North Central division, counties in the East North Central, Mountain, and South Atlantic divisions had increased odds of being Opioid high-risk counties (East North Central: odds ratio [OR], 2.21; 95% CI, 1.19-4.12; Mountain: OR, 4.15; 95% CI, 1.34-12.89; and South Atlantic: OR, 2.99; 95% CI, 1.26-7.11). A 1% increase in unemployment was associated with increased odds (OR, 1.09; 95% CI, 1.03-1.15) of a county being an Opioid high-risk county. Counties with an additional 10 primary care clinicians per 100 000 population had a reduced risk of being Opioid high-risk counties (OR, 0.89; 95% CI, 0.85-0.93), as did counties that were micropolitan (vs metropolitan) (OR, 0.67; 95% CI, 0.50-0.90) and those that had an additional 1% of the population younger than 25 years (OR, 0.95; 95% CI, 0.92-0.98). Conclusions and Relevance Counties with low availability of OUD medication providers and high rates of Opioid Overdose mortality were less likely to be micropolitan and have lower primary care clinician density, but were more likely to be in the East North Central, South Atlantic, or Mountain division and have higher rates of unemployment. Strategies to increase medication treatment must account for these factors.
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Changing Trends in Opioid Overdose Deaths and Prescription Opioid Receipt Among Veterans.
American Journal of Preventive Medicine, 2019Co-Authors: Talya Peltzman, John F. Mccarthy, Elizabeth M. Oliva, Jodie A. Trafton, Amy S.b. BohnertAbstract:Introduction To inform Overdose prevention, this study assessed both recent trends in Opioid Overdose mortality across Opioid categories and receipt of prescription Opioid analgesics among Veterans who died from Overdose in the Veterans Health Administration. Methods Using Veterans Health Administration records linked to National Death Index data, annual cohorts (2010–2016) of Veterans who received Veterans Health Administration care were obtained and were examined by Opioid Overdose categories (natural/semisynthetic Opioids, heroin, methadone, and other synthetic Opioids) on (1) Overdose rates and changes in rates adjusted for age, sex, and race/ethnicity; and (2) Veterans Health Administration prescription Opioid receipt. Analyses were conducted in 2018. Results The overall rate of Opioid Overdose among Veterans increased from 14.47 per 100,000 person-years in 2010 to 21.08 per 100,000 person-years in 2016 (adjusted rate ratio=1.65, 95% CI=1.51, 1.81). There was a decline in methadone Overdose (adjusted rate ratio=0.66, 95% CI=0.51, 0.84) and no significant change in natural/semisynthetic Opioid Overdose (adjusted rate ratio=1.08, 95% CI=0.94, 1.24). However, the synthetic Opioid Overdose rate (adjusted rate ratio=5.46, 95% CI=4.41, 6.75) and heroin Overdose rate (adjusted rate ratio=4.91, 95% CI=3.92, 6.15) increased substantially. Among all Opioid Overdose decedents, prescription Opioid receipt within 3 months before death declined from 54% in 2010 to 26% in 2016. Conclusions Opioid Overdose rates among Veterans Health Administration Veterans increased because of increases in heroin and synthetic Opioid Overdose rates. Prescriptions of Opioids declined among patients who died from all categories of Opioid Overdose; by 2016, only a minority received an Opioid analgesic from Veterans Health Administration within 3 months of Overdose. Future prevention efforts should extend beyond patients actively receiving Opioid prescriptions.
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139 Development of the system for Opioid Overdose surveillance (s.o.s.)
Injury Prevention, 2017Co-Authors: Mahshid Abir, Amy S.b. Bohnert, Aaron Dora-laskey, Amanda Kogowski, Rekar K. Taymour, Richard Medlin, Rebecca M. CunninghamAbstract:Statement of Purpose In 2015, a record number of Americans died of an Opioid-involved Overdose, bringing devastation to families and communities in urban and rural communities alike. Now, more people in America die from drug Overdoses than motor vehicle collisions. In response to this alarming public health crisis, the Office of National Drug Control Policy is supporting the development of Opioid Overdose monitoring systems in High Intensity Drug Trafficking Areas (HIDTA). In collaboration, the University of Michigan Injury Centre and the Acute Care Research Unit (ACRU) are developing and piloting a real-time System for Opioid Overdose Surveillance (S.O.S.) in the Michigan HIDTA. Approach We are developing a real-time surveillance system for fatal and non-fatal Overdoses in Washtenaw County by linking data from two EDs, emergency medical services (EMS), and data from the Washtenaw County Medical Examiner (ME) office. Information for individuals with Overdose will be linked through probabilistic matching to track individuals through their encounters with EMS and EDs for Overdose and deaths including those that are reported by the MEs office. Using location data, Overdoses will be geo-coded to identify Overdose ‘hot-spots’ and this information will be available in a timely manner to public health and public safety officials. Results We anticipate that S.O.S. will provide real-time surveillance of daily EMS and ED encounters for Opioid Overdose, supplemented periodically with ME data. Conclusions By connecting opiate Overdose data from the mentioned data sources, a comprehensive local real-time surveillance system may be developed. This system can serve as a prototype for a statewide Overdose surveillance system. Significance S.O.S. will increase the timeliness and quality of Opioid Overdose reporting and inform regional public safety and public health strategies to reduce fatal and non-fatal Overdoses.
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association between Opioid prescribing patterns and Opioid Overdose related deaths
JAMA, 2011Co-Authors: Amy S.b. Bohnert, John F. Mccarthy, Marcia Valenstein, Matthew J Bair, Dara Ganoczy, Mark A Ilgen, Frederic C BlowAbstract:Context The rate of prescription Opioid–related Overdose death increased substantially in the United States over the past decade. Patterns of Opioid prescribing may be related to risk of Overdose mortality. Objective To examine the association of maximum prescribed daily Opioid dose and dosing schedule (“as needed,” regularly scheduled, or both) with risk of Opioid Overdose death among patients with cancer, chronic pain, acute pain, and substance use disorders. Design Case-cohort study. Setting Veterans Health Administration (VHA), 2004 through 2008. Participants All unintentional prescription Opioid Overdose decedents (n = 750) and a random sample of patients (n = 154 684) among those individuals who used medical services in 2004 or 2005 and received Opioid therapy for pain. Main Outcome Measure Associations of Opioid regimens (dose and schedule) with death by unintentional prescription Opioid Overdose in subgroups defined by clinical diagnoses, adjusting for age group, sex, race, ethnicity, and comorbid conditions. Results The frequency of fatal Overdose over the study period among individuals treated with Opioids was estimated to be 0.04%.The risk of Overdose death was directly related to the maximum prescribed daily dose of Opioid medication. The adjusted hazard ratios (HRs) associated with a maximum prescribed dose of 100 mg/d or more, compared with the dose category 1 mg/d to less than 20 mg/d, were as follows: among those with substance use disorders, adjusted HR = 4.54 (95% confidence interval [CI], 2.46-8.37; absolute risk difference approximation [ARDA] = 0.14%); among those with chronic pain, adjusted HR = 7.18 (95% CI, 4.85-10.65; ARDA = 0.25%); among those with acute pain, adjusted HR = 6.64 (95% CI, 3.31-13.31; ARDA = 0.23%); and among those with cancer, adjusted HR = 11.99 (95% CI, 4.42-32.56; ARDA = 0.45%). Receiving both as-needed and regularly scheduled doses was not associated with Overdose risk after adjustment. Conclusion Among patients receiving Opioid prescriptions for pain, higher Opioid doses were associated with increased risk of Opioid Overdose death.