Feasibility of a Novel COVID-19 Telehealth Care Management Program Among Individuals Receiving Treatment for Opioid Use Disorder: Analysis of a Pilot Program.

BACKGROUND: The emergence of COVID-19 exacerbated the existing epidemic of opioid use disorder (OUD) across the United States due to the disruption of in-person treatment and support services. Increased use of technology including telehealth and the development of new partnerships may facilitate coordinated treatment interventions that comprehensively address the health and well-being of individuals with OUD. OBJECTIVE: The analysis of this pilot program aimed to determine the feasibility of delivering a COVID-19 telehealth care management program using SMS text messages for patients receiving OUD treatment. METHODS: Eligible individuals were identified from a statewide opioid treatment program (OTP) network. Those who screened positive for COVID-19 symptoms were invited to connect to care management through a secure SMS text message that was compliant with Health Insurance Portability and Accountability Act standards. Care management monitoring for COVID-19 was provided for a period of up to 14 days. Monitoring services consisted of daily SMS text messages from the care manager inquiring about the participant's physical health in relation to COVID-19 symptoms by confirming their temperature, if the participant was feeling worse since the prior day, and if the participant was experiencing symptoms such as coughing or shortness of breath. If COVID-19 symptoms worsened during this observation period, the care manager was instructed to refer participants to the hospital for acute care services. The feasibility of the telehealth care management intervention was assessed by the rates of adoption in terms of program enrollment, engagement as measured by the number of SMS text message responses per participant, and retention in terms of the number of days participants remained in the program. RESULTS: Between January and April 2021, OTP staff members referred 21 patients with COVID-19 symptoms, and 18 (82%) agreed to be contacted by a care manager. Participants ranged in age from 27 to 65 years and primarily identified as female (n=12, 67%) and White (n=15, 83%). The majority of participants were Medicaid recipients (n=14, 78%). There were no statistically significant differences in the demographic characteristics between those enrolled and not enrolled in the program. A total of 12 (67%) patients were enrolled in the program, with 2 (11%) opting out of SMS text message communication and choosing instead to speak with a care manager verbally by telephone. The remaining 10 participants answered a median of 7 (IQR 4-10) SMS text messages and were enrolled in the program for a median of 9 (IQR 7.5-12) days. No participants were referred for acute care services or hospitalized during program enrollment. CONCLUSIONS: These results demonstrate the feasibility of a novel telehealth intervention to monitor COVID-19 symptoms among OTP patients in treatment for OUD. Further research is needed to determine the applicability of this intervention to monitor patients with comorbid chronic conditions in addition to the acceptability among patients and providers using the SMS text messaging modality.

Opioid-stimulant trends in overdose toxicology by race, ethnicity, & gender: An analysis in Delaware, 2013-2019.

Recent upticks of stimulant presence in overdose deaths suggest the opioid epidemic is morphing, which raises questions about what drugs are involved and who is impacted. We investigate annual and growth rate trends in combined opioid-stimulant overdose toxicology between 2013 and 2019 for White, Black, and Hispanic male and female decedents in Delaware. During these years, toxicology shifted to illegal drugs for all with fentanyl leading the increase and opioid-cocaine combinations rising substantially. While combined opioid-cocaine toxicology grew among Black and Hispanic Delawareans, White males continue to report the highest rates overall. These findings depart from historical patterns and may challenge existing opioid epidemic policies.

An Examination of Seasonal Trends in Delaware Drug Overdoses, 2016-2020.

Objective: To examine whether overdose deaths and related metrics-overdose calls for service to police and non-fatal overdose emergency department visits-in Delaware follow within-year (i.e., seasonal) patterns during the most recent years of the opioid epidemic (2016-2020). Methods: We begin by providing descriptive statistics on yearly trends in overdose metrics, followed by Analysis of Variance (ANOVA) to analyze whether seasonal variations have a significant impact on the patterns of Delaware's overdose metrics while controlling for annual variations. Results: We find yearly variations across the three overdose-related metrics, with overdose deaths reporting the only consistent increases per year. Within-year, or seasonal, variations show the spring months have the most consistent increases in overdose deaths and overdose calls for service across years we studied. Finally, we report significant differences for all overdose metrics across years and seasons. Conclusions: As in prior studies, we find significant variation in overdose-related metrics by season in Delaware. Policy Implications: These findings lend support to existing interventions in slowing yearly growth in overdose deaths. However, allocation of resources and interventions to specific times of the year-when overdoses are highest-may further reduce risks and harms.

Prescription Drug Histories among Drug Overdose Decedents in Delaware.

Background: The US opioid epidemic largely featured deaths from prescribed medications during Wave 1 (1990-2010), but its progression since then has resulted more so from deaths to illegal opioids-such as heroin (Wave 2 - 2010-2013) and fentanyl (Wave 3 - 2013-present). As deaths to illegally manufactured fentanyl have increased, attention to the role of prescribed opioids may be waning. However, the shifting nature of today's opioid epidemic demands we monitor how both legal and illegal drugs are involved in overdose deaths. Objectives: The purpose of our study is to investigate the prescription drug (Rx) records of overdose death decedents to illuminate the continued role of prescribed medications in Wave 3 deaths. Methods: We matched drug overdose death data and prescription drug monitoring data to investigate the prescription drug records (i.e. types of opioids and other medications) of Delaware, USA, decedents who died from a drug overdose death between January 1, 2013, and March 31, 2015 (27 months). Results: Fentanyl decedents differed significantly from other decedents in prescribed medications, including the amount and proximity of opioid and Rx fentanyl prescriptions before death. These relationships held while controlling for demographic characteristics and contributing health conditions. Conclusions: Our findings show a continued presence of Rx opioids in overdose deaths and that those dying from fentanyl had different Rx records than those who died from other drugs. Continued monitoring of Rx drugs, improved toxicology testing and greater data access for more research should follow to inform effective interventions.

Is the Gender Gap in Overdose Deaths (Still) Decreasing? An Examination of Opioid Deaths in Delaware, 2013-2017.

OBJECTIVE: Drug overdoses among men have historically outnumbered those among women by a large margin. Yet, U.S. research on the first wave of the opioid epidemic involving prescription opioids has found women to be at increased risk. The current study considers if the narrowing gender gap in overdose deaths, as observed during the first wave, has continued into the most recent third wave, dominated by synthetic opioid deaths. This requires consideration of interactions between gender, age, and type of drug implicated. METHOD: Drawing on 2013-2017 Delaware toxicology reports for a total of 890 overdose deaths involving opioids, we distinguished between four gender/age groups--women 15-44, women 45-64, men 15-44, and men 45-64--to calculate crude death rates, male-to-female death rate ratios, and younger-to-older death rate ratios by type of opioid. RESULTS: Opioid overdose death rates during the third wave increased among both men (+102%) and women (+46%), but the larger increase among men resulted in an increase in the male-to-female death rate ratio (from 1.9 to 2.6). This trend was driven by the growing contribution of fentanyl (from 16% to 76%) and heroin overdose deaths (from 27% to 50%) compared with other opioid overdose deaths, which disproportionately affected men and younger individuals. Higher male-to-female death rate ratios were observed among older, compared with younger, individuals. CONCLUSIONS: Overdose deaths seem to have returned to a historically familiar pattern of dominance by younger males. Our findings suggest the gender-age distribution in deaths to specific opioid types must be considered for effective intervention.

Understanding Geographic and Neighborhood Variations in Overdose Death Rates.

The current opioid epidemic continues to challenge us in new and potentially troubling ways. For example, research today finds more overdose deaths occurring in rural, rather than urban, geographic areas. Yet, studies have often ignored heterogeneities within these spaces and the neighborhood variations therein. Using geodemographic classification, we investigate neighborhood differences in overdose death rates by geographical areas to further understand where and among what groups the problem might be most concentrated. For deaths between 2013 and 2016, we find significant variation in rates among neighborhoods, defined by their socio-economic and demographic characteristics. For example, overdose death rates vary up to 13-fold among neighborhoods within geographic areas. Our results overall show that while the rural or urban classification of a geographic area is important in understanding the current overdose problem, a more segmented analysis by neighborhood's socio-economic and demographic makeup is also necessary.

Variations in clubbers' substance use by individual and scene-level factors.

Research on clubbing spans numerous fields and adopts diverse approaches to the populations in question. Yet, a somewhat homogenous narrative has emerged about clubbers and substance use, one that focuses on overconsumption, risky behavior, and considerable consequence. The purpose of our study is to unpack this narrative by exploring how the substance use patterns of clubbing populations differ by individual and scene-level factors. From this, we hope to increase an understanding of how social and cultural factors impact the relationship between clubbers and substance use. We draw on direct observation of 29 club events and interviews with 51 respondents from the hip hop (HH) and electronic dance music (EDM) scenes in Philadelphia to inform our research objective. Analyses revealed two broad criteria on which a substance use-based typology of clubbers can be offered: motivations for clubbing and level and type of scene involvement. From these two dimensions, we are able to distinguish among three types of clubbers: drug sub-cultural members, commercial clubbers, and music connoisseurs. Drug sub-cultural members reported early onset of drug use and a greater frequency of current drug use at largely underground EDM club events and outside them as well. Commercial clubbers had benign histories with drugs, but they reported attending mostly commercialized HH events to get drunk and court the opposite sex. Music connoisseurs reported minimal current drug and alcohol use at exclusively underground EDM and HH club events, following from, in some cases, extensive histories with drugs and alcohol. The differences between these three groups' substance use patterns, we contend, can be attributed to the interplay between numerous social and cultural factors not previously considered.

Variaciones en el uso de substancias entre clubbers de acuerdo con factores individuales y de nivel de escena / Variations in clubbers’ substance use by individual and scene-level factors

La investigación sobre clubes nocturnos abarca numerosos campos y adopta diversos enfoques sobre las poblaciones examinadas. Sin embargo, sólo ha emergido una narrativa un tanto homogénea sobre clubbers y uso desustancias, aquella que se centra en el abuso, los comportamientos de riesgo y sus considerables consecuencias. El objetivo de este estudio es desarmar esta narrativa explorando cómo los patrones de uso de sustancias de las poblaciones de clubbers difieren en función de factores individuales y de nivel de escena. De esta forma, esperamos incrementar la comprensión sobre la forma en que los factores culturales y sociales tienen un impacto en las relaciones entre clubbers y consumo de sustancias. Para ello recurrimos a la observación directa de eventos en 29 clubes y, para completar nuestros objetivos de investigación, realizamos entrevistas a 51 participantes de la escena hip hop (HH) y de música electrónica de baile (MEB) de Philadelphia. El análisis reveló dos criterios amplios para proporcionar una tipología basada en el consumo de drogas de los clubbers: motivaciones para el clubbing y nivel y tipo de participación en dicha escena. Partiendo de estas dos dimensiones, pudimos distinguir tres tipos de clubbers: miembros de la subcultura de la droga, clubbers comerciales y entendidos en música. Los miembros de la subcultura de la droga describieron comienzos tempranos en el uso de la droga, así como frecuencias actuales de uso mayores tanto en eventos de clubes de MEB, en gran parte clandestinos, como fuera de ellos. Los clubbers comerciales relataron historias benignas sobre uso de drogas, e indicaron haber asistido a eventos en su mayor parte comercializados de HH para emborracharse y tratar de conquistar al sexo opuesto. Los entendidos en música refirieron, en la actualidad, consumos mínimos de drogas y alcohol exclusivamente en eventos clandestinos de MEB y HH, después de, en algunos casos, historiales de uso extensivo de drogas y alcohol. Las diferencias entre estos tres grupos, con distintos modelos de consumo de sustancias, argüimos, pueden atribuirse a la interacción entre los numerosos factores sociales y culturales no considerados anteriormente (AU)

Research on clubbing spans numerous fields and adopts diverse approaches to the populations in question. Yet, a somewhat homogenous narrative has emerged about clubbers and substance use, one that focuses on over consumption, risky behavior, and considerable consequence. The purpose of our study is to unpack this narrative by exploring how the substance use patterns of clubbing populations differ by individual and scene-level factors. From this, we hope to increase an understanding of how social and cultural factors impact the relationship between clubbers and substance use. We draw on direct observation of 29 club events and interviews with 51respondents from the hip hop (HH) and electronic dance music (EDM) scenes in Philadelphia to inform our research objective. Analyses revealed two broad criteria on which a substance use-based typology of clubbers can be offered: motivations for clubbing and level and type of scene involvement. From these two dimensions, we are able to distinguish among three types of clubbers: drug sub-cultural members, commercial clubbers, and music connoisseurs. Drug sub-cultural members reported early onset of drug use and a greater frequency of current drug use at largely underground EDM club events and outside them as well. Commercial clubbers had benign histories with drugs, but they reported attending mostly commercialized HH events to get drunk and court the opposite sex. Music connoisseurs reported minimal current drug and alcohol use at exclusively underground EDM and HH club events, following from, in some cases, extensive histories with drugs and alcohol. The differences between these three groups’ substance use patterns, we contend, can be attributed to the interplay between numerous social and cultural factors not previously considered (AU)

Marginality among older injectors in today's illicit drug culture: assessing the impact of ageing.

AIMS: As conceptualized by Robert Park in 1928, the 'marginal man' occupies simultaneously an intermediate point between two distinct cultures that embody some level of contradictory normative expectations, behaviors and beliefs. This paper explores the influence of ageing and social change on the creation of marginality among injection drug users over age 50 who have been chronic heroin users since their youth. DESIGN: Our data are drawn from in-depth interviews with 40 (28 male and 12 female) not-in-drug-treatment, active injecting drug users between the ages of 18 and 68. SETTING: Our sample was recruited using street outreach as part of a larger, community-based study conducted from a converted storefront in a high crime, economically depressed neighborhood on the west side of Chicago. FINDINGS: As they aged, and under the pressures of social change, the older users whom we studied moved from center positioning in the illicit drug culture of their youth to the margins of a differing drug culture of today where they participate largely unseen by others. Nostalgic for the 'Old School' mores of the past, and unable to transcend or assimilate fully into the cultural practices and norms of the 'New', they respond to their predicament by embracing 'poise' in the face of loneliness, stress and fear of victimization. CONCLUSIONS: Our respondents' experiences draw attention to the need to refine the field's theoretical and practical understandings of what it means to be marginal and its consequences for older drug users and people in general. The results also point to what happens when society changes but some of its members do not.