Factors Associated with Opioid-Related Fatal and Non-fatal Overdose

Transcription

1 Factrs Assciated with Opiid-Related Fatal and Nn-fatal Overdse Understanding the factrs assciated with piid-related fatal and nn-fatal verdse and can help practitiners assess, plan fr, and select interventins t address them. Researchers have identified a variety f factrs that place individuals at increased risk fr piid verdse (and death in the event f an verdse). These can be rganized int the fllwing categries: Opiid Use and Misuse Ability t Prcess Opiids Chrnic Pain and Mental Health Opiid Access and Supply Opiid Knwledge and Perceptins Nn-fatal Overdse OPIOID USE AND MISUSE Bth medical and illicit use f piids can place individuals a risk f fatal and nn-fatal verdse. Risk factrs assciated with the medical use f prescriptin piids include: Prescriptins that are lng-term, r fr high dses r lng-acting piids Having cncurrent prescriptins (fr example, fr multiple piids r fr bth piids and benzdiazepines) Risk factrs assciated with the illicit use f any piids include: Nn-medical use f prescriptin piids Use f herin and ther nn-prescriptin piids Illicit use f piids in cmbinatin with ther cntrlled substances (similar t medical use) PAGE 1 Develped under the Substance Abuse and Mental Health Services Administratin s Center fr the Applicatin f Preventin Technlgies task rder. Reference #HHSS I/HHSS T. Fr training use nly. March 21, PAGE 1

2 Finally, use f piids alne (withut ther individuals arund t respnd) is assciated with increased risk f death in the event f an verdse. ABILITY TO PROCESS OPIOIDS An individual s ability t physically prcess an piid is influenced by several factrs that can increase ne s risk fr fatal r nn-fatal verdse: piid dependence, changes in piid tlerance, and cmprmised physical health. Opiid dependence, a physical adaptatin t piids that prduces withdrawal symptms when piid use stps, may lead t piid misuse r additin, which is assciated with increased verdse risk Risk factrs assciated with piid tlerance (the bdy s ability t prcess and experience the effects f a certain amunt f a substance) include: An increase in tlerance (needing mre f a drug in rder t experience the same effect) Decrease in tlerance with time away frm use (due t hspitalizatin, treatment, r incarceratin) Risk factrs assciated with physical health prblems include: A cmprmised immune system Pulmnary dysfunctin (including lung damage and disrders such as asthma, emphysema, r sleep apnea) Liver dysfunctin CHRONIC PAIN AND MENTAL HEALTH In additin t the physical health factrs that may influence an individual s ability t prcess piids, several ther physical and mental health issues as assciated with an increased risk fr piidrelated fatal and nn-fatal verdse. Chrnic pain, defined as pain that lasts lnger than 3 mnths r past the time an injury is expected t heal Mental health disrders, including depressin, anxiety, and/r substance use disrders Risk factrs assciated with adverse life experiences include: Having witnessed a family member verdse Financial struggles, including unemplyment Hmelessness PAGE 2 Develped under the Substance Abuse and Mental Health Services Administratin s Center fr the Applicatin f Preventin Technlgies task rder. Reference #HHSS I/HHSS T. Fr training use nly. March 21, PAGE 2

3 OPIOID ACCESS AND SUPPLY Factrs that increase the availability f prescriptin and nn-prescriptin piids such as piid prescribing practices, diversin f prescriptin piids, and changes in the lcal drug supply as assciated with increased risk fr fatal and nn-fatal verdse. Risk factrs assciated with piid prescribing practices include: Increases in piid dsage and/r duratin f use, and number f pills prescribed (that is, days supply) Increases in the number f piid prescriptins written The diversin f prescriptin piids r redirectin f cntrlled substances frm their lawful purpse t illicit use is assciated with increased risk fr piid-related verdse. Prescriptin drugs can be diverted thrugh peple such as: Friends r relatives Healthcare prviders Drug dealers Risk factrs assciated with changes in the lcal drug supply include: Increases in the availability and decreases in the cst f herin Increases in the purity f herin Increases in the number f street drugs, including herin, testing psitive fr fentanyl and ther ptent piids OPIOID KNOWLEDGE AND PERCEPTIONS An individual s lack f knwledge abut piids and risks assciated with their misuse, including verdse, and their perceptins twards these drugs can place them at increased risk fr verdse. Risk factrs assciated with piid knwledge and perceptins include: A lack f understanding r awareness f verdse risks (such as the risks assciated with using piids and ther substances cncurrently) A lw perceptin f the harms assciated with piids, specifically prescriptin piids NON-FATAL OVERDOSE Experiencing a nn-fatal piid verdse in the past increases peple s risk f suffering a fatal verdse in the future. PAGE 3 Develped under the Substance Abuse and Mental Health Services Administratin s Center fr the Applicatin f Preventin Technlgies task rder. Reference #HHSS I/HHSS T. Fr training use nly. March 21, PAGE 3

4 Risk factrs assciated with nn-fatal verdse include: The specific factrs that caused the initial verdse, including high-risk piid misuse. Any physical health prblems caused by the verdse itself, which may include damage t the brain, heart, liver, r kidneys. REFERENCES Baumblatt, J. A. G., Wiedeman, C., Dunn, J. R., Schaffner, W., Paulzzi, L. J., & Jnes, T. F. (2014). High-risk use by patients prescribed piids fr pain and its rle in verdse deaths. JAMA Internal Medicine, 174(5), Betts, K. S., McIlwraith, F., Dietze, P., Whittaker, E., Burns, L., Cgger, S., & Alati, R. (2015). Can differences in the type, nature r amunt f plysubstance use explain the increased risk f nn-fatal verdse amng psychlgically distressed peple wh inject drugs? Drug and Alchl Dependence, 154, Bhnert, A. S. B., Valenstein, M., Bair, M. J., Ganczy, D., McCarthy, J. F., Ilgen, M. A., & Blw, F. C. (2011). Assciatin Between Opiid Prescribing Patterns and Opiid Overdse-Related Deaths. JAMA, 305(13), Bnar, E. E., & Bhnert, A. S. (2016). Perceived severity f and susceptibility t verdse amng injectin drug users: Relatinships with verdse histry. Substance Use & Misuse, 51(10), Green, T. C., Black, R., Grimes Serran, J. M., Budman, S. H., & Butler, S. F. (2011). Typlgies f prescriptin piid use in a large sample f adults assessed fr substance abuse treatment. PLOS ONE, 6(11), e Jhnsn, E. M., Lanier, W. A., Merrill, R. M., Crk, J., Prucznik, C. A., Rlfs, R. T., & Sauer, B. (2013). Unintentinal prescriptin piid-related verdse deaths: descriptin f decedents by next f kin r best cntact, Utah, Jurnal f General Internal Medicine, 28(4), Kinner, S. A., Milly, M. J., Wd, E., Qi, J., Zhang, R., & Kerr, T. (2012). Incidence and risk factrs fr nn-fatal verdse amng a chrt f recently incarcerated illicit drug users. Addictive Behavirs, 37(6), Neira-León, M., Barri, G., Brav, M. J., Brugal, M. T., de la Fuente, L., Dming-Salvany, A., Pulid, J., Sants, S., & Prject Itinere Grup. (2011). Infrequent piid verdse risk reductin behaviurs amng yung adult herin users in cities with wide cverage f HIV preventin prgrammes. Internatinal Jurnal f Drug Plicy, 22(1), Peirce, G. L., Smith, M. J., Abate, M. A., & Halversn, J. (2012). Dctr and pharmacy shpping fr cntrlled substances. Medical Care, 50(6), Riley, E. D., Evans, J. L., Hahn, J. A., Bricen, A., Davidsn, P. J., Lum, P. J., & Page, K. (2016). A lngitudinal study f multiple drug use and verdse amng yung peple wh inject drugs. American Jurnal f Public Health, 106(5), Siegler, A., Tuazn, E., Bradley O Brien, D., & Pane, D. (2014). Unintentinal piid verdse deaths in New Yrk City, : A place-based apprach t reduce risk. Internatinal Jurnal f Drug Plicy, 25(3), Silva, K., Schrager, S. M., Kecjevic, A., & Lankenau, S. E. (2013). Factrs assciated with histry f nn-fatal verdse amng yung nnmedical users f prescriptin drugs. Drug and Alchl Dependence, 128(1-2), PAGE 4 Develped under the Substance Abuse and Mental Health Services Administratin s Center fr the Applicatin f Preventin Technlgies task rder. Reference #HHSS I/HHSS T. Fr training use nly. March 21, PAGE 4

5 Yarbrugh, B. J., Stumb, S. P., Janff, S. L., Yarbrugh, M. T., McCarty, D., Chilcat, H. D., Cplan, P. M., & Green, C. A. (2016 ). Understanding piid verdse characteristics invlving prescriptin and illicit piids: A mixed methds analysis. Drug and Alchl Dependence, 167, Yang, Z., Wilsey, B., Bhm, M., Weyrich, M., Ry, K., Ritley, D., Jnes, C., & Melnikw, J. (2015). Defining risk f prescriptin piid verdse: pharmacy shpping and verlapping prescriptins amng lng-term piid users in medicaid. The Jurnal f Pain, 16(5), Zedler, B., Xie, L., Wang, L., Jyce, A., Vick, C., Karibury, F., Rajan, P., Baser, O., & Murrelle, L. (2014). Risk factrs fr serius prescriptin piid-related txicity r verdes amng Veterans Health Administratin patients. Pain Medicine, 15(11), Zedler, B., Xie, L., Wang, L., Jyce, A., Vick, C., Brigham, J., Karibury, F., Baser, O., & Murrelle, L. (2015). Develpment f a risk index fr serius prescriptin piid-induced respiratry depressin r verdse in Veterans Health Administratin patients. Pain Medicine, 16(8), PAGE 5 Develped under the Substance Abuse and Mental Health Services Administratin s Center fr the Applicatin f Preventin Technlgies task rder. Reference #HHSS I/HHSS T. Fr training use nly. March 21, PAGE 5