Touchpoints – Opportunities to predict and prevent opioid overdose: A cohort study

Details

• Alternative Title:
  Drug Alcohol Depend
• Personal Author:
  Larochelle, Marc R. ; Bernstein, Ryan ; Bernson, Dana ; Land, Thomas ; Stopka, Thomas J. ; Rose, Adam J. ; Bharel, Monica ; Liebschutz, Jane M. ; Walley, Alexander Y.
• Description:
  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.
  
  
• Subjects:
  Adolescent Adult Analgesics, Opioid Article Child Criminal Law Drug Overdose Drug Prescriptions Female Forecasting Humans Male Massachusetts Middle Aged Opioid-Related Disorders Opioid Overdose Opioid Prescribing Patient Acceptance Of Health Care Population Attributable Fraction Retrospective Studies Risk Standardized Mortality Ratio Young Adult

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• Source:
  Drug Alcohol Depend. 204:107537
• Pubmed ID:
  31521956
• Pubmed Central ID:
  PMC7020606
• Document Type:
  Journal Article
• Funding:
  K23 DA042168/DA/NIDA NIH HHS/United States ; U01 CE002780/CE/NCIPC CDC HHS/United States
• Volume:
  204
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:8d7da306d716bce0bc9591339f65c64cf8b6f6690e6990a17241dac6f14e357d
• Download URL:
  https://stacks.cdc.gov/view/cdc/101065/cdc_101065_DS1.pdf
• File Type:
  [PDF - 155.48 KB ]