Opioid dose and risk of suicide

Chronic pain is associated with increased risk of suicide, and opioids are commonly used to treat moderate to severe pain. However, the association between opioid dose and suicide mortality has not been examined closely. This retrospective data analysis described the risk of suicide associated with differing prescribed opioid doses. Data were from Veterans Affairs health care system treatment records and the National Death Index. Records analyzed were those of Veterans Affairs patients with chronic pain receiving opioids in fiscal years 2004 to 2005 (N = 123,946). Primary predictors were maximum prescribed morphine-equivalent daily opioid dose and opioid fill type. The main outcome measured was suicide death, by any mechanism, and intentional overdose death during 2004 to 2009. Controlling for demographic and clinical characteristics, higher prescribed opioid doses were associated with elevated suicide risk. Compared with those receiving ≤20 milligrams/day (mg/d), hazard ratios were 1.48 (95% confidence intervals [CI], 1.25-1.75) for 20 to <50 mg/d, 1.69 (95% CI, 1.33-2.14) for 50 to <100 mg/d, and 2.15 (95% CI, 1.64-2.81) for 100+ mg/d. The magnitude of association between opioid dose and suicide by intentional overdose was not substantially different from that observed for the overall measure of suicide mortality. Risk of suicide mortality was greater among individuals receiving higher doses of opioids, and treatment providers may want to view high opioid dose as a marker of elevated risk for suicide. Additional research is needed on opioid use, pain treatment, and suicide

Predictors of injury-related and non-injury-related mortality among veterans with alcohol use disorders

To describe the association between alcohol use disorders (AUDs) and mortality and to examine risk factors for and all-cause, injury-related and non-injury-related mortality among those diagnosed with an AUD.Department of Veterans Affairs, Veterans Health Administration (VHA).A cohort of individuals who received health care in VHA during the fiscal year (FY) 2001 ( n  = 3 944 778), followed from the beginning of FY02 through the end of FY06.Demographics and medical diagnoses were obtained from VHA records. Data on mortality were obtained from the National Death Index.Controlling for age, gender and race and compared to those without AUDs, individuals with AUDs were more likely to die by all causes [hazard ratio (HR) = 2.30], by injury-related (HR = 3.29) and by non-injury-related causes (HR = 2.21). Patients with AUDs died 15 years earlier than individuals without AUDs on average. Among those with AUDs, Caucasian ethnicity and all mental illness diagnoses that were assessed were associated more strongly with injury-related than non-injury-related mortality. Also among those with AUDs, individuals with medical comorbidity and older age were at higher risk for non-injury related compared to injury-related mortality.In users of a large health-care system, a diagnosis of an AUD is associated significantly with increased likelihood of dying by injury and non-injury causes. Patients with a diagnosis of an AUD who die from injury differ significantly from those who die from other medical conditions. Prevention and intervention programs could focus separately upon selected groups with increased risk for injury or non-injury-related death.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/79146/1/j.1360-0443.2010.03024.x.pd

HIV Testing and Conspiracy Beliefs Regarding the Origins of HIV among African Americans

Abstract Conspiracy beliefs regarding the origins of HIV are common among African Americans, and have been associated with engaging in HIV risk behaviors but also with earlier diagnosis among HIV patients. The objective of the present study was to test the association of HIV serostatus testing with conspiracy beliefs. A total of 1430 African Americans from low-income neighborhoods with high rates of drug use were surveyed in 1997-1999 in face-to-face interviews. Two 4-point items assessed if participants agreed that AIDS was started by an experiment that went wrong and AIDS was created to kill blacks and poor folks. A binary variable indicated if the respondent agreed with the statements, on average. 22.5% of the sample endorsed conspiracy beliefs, 4.0% of whom reported not having had an HIV test, compared to 7.7% of those who did not endorse conspiracy beliefs. In multivariable logistic regression modeling, never having had an HIV test was significantly associated with conspiracy beliefs (adjusted odds ratio [AOR]=0.43, 95% confidence interval [CI]=1.3-4.3), having a high school education (AOR=0.55, CI=0.35-0.84), having depression (AOR=1.61, CI=1.02-2.52), female gender (AOR=0.54, CI=0.34-0.86), younger age, and a history of injection drug use (AOR=0.36, CI=0.23-0.56), but not sex risk behaviors (multiple partners, irregular condom use). The finding that individuals who have conspiracy beliefs are more likely to have been tested for HIV may partially explain why HIV-positive individuals who endorse conspiracy beliefs are more likely to obtain an earlier diagnosis.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/78123/1/apc.2009.0061.pd

Patterns and correlates of drug-related ED visits: results from a national survey

Drug treatment can be effective in community-based settings, but drug users tend to under-utilize these treatment options and instead seek services in emergency departments (ED) and other acute care settings. The goals of this study were to describe prevalence and correlates of drug-related ED visits

Improving Access to Primary and Pain Care for Patients Taking Opioids for Chronic Pain in Michigan: Recommendations from an Expert Panel

This multidisciplinary expert panel was convened to generate recommendations to address the limited access to care that patients experience when taking opioids for chronic pain. Recent policies and guidelines instituted to reduce inappropriate opioid prescribing have had unintended consequences for the 5-8 million patients taking long-term opioid therapy for chronic pain in the U.S. As providers discontinue prescribing and turn away patients dependent on opioids, this population faces limited access to both primary and pain-related care. The root causes of this access issue can be attributed to several overarching barriers, including new opioid-related policies, payment models, a lack of care coordination, stigma, and racial biases. Over multiple rounds of deliberation, the panel brainstormed possible solutions, considering feasibility, impact, and importance, and ultimately ranked their final recommendations in order of implementation priority. The final list included 11 recommendations, from which three overarching themes emerged: 1. Improving care models to better support patients with chronic pain Three recommendations involved improving care models, including the top two: increasing reimbursement for the time needed to treat complex chronic pain and establishing coordinated care models that bundle payments for multimodal pain treatment. 2. Enhancing provider education and training Four recommendations involving provider education efforts received slightly lower rankings and included training on biopsychosocial factors of pain care and clarifying the continuum between physical dependency and opioid use disorder. 3. Implementing practices to reduce racial biases and inequities The remaining four recommendations address racial biases and inequities, ranging from standardizing pain management protocols to reduce bias to increasing recruitment and retention of providers from underrepresented racial minorities. Throughout the process, panelists emphasized the interconnectedness of their proposed solutions, and indicated that multiple approaches are likely needed to meaningfully improve access to care for this patient population. Importantly, though this panel was convened in Michigan, and its expertise grounded in Michigan’s healthcare ecosystem, there are millions of patients taking opioids for chronic pain across the country, and reports of limited access to care are not unique to Michigan. Consequently, there may also be opportunity to apply these recommendations more broadly, in other states and at multiple levels of the United States healthcare system.This research was funded by the Michigan Health Endowment Fund (grant # R-1808-143371).http://deepblue.lib.umich.edu/bitstream/2027.42/168420/1/Lagisetty - Improving Access to Care for Patients Taking Opioids - 2021.pdfDescription of Lagisetty - Improving Access to Care for Patients Taking Opioids - 2021.pdf : White PaperSEL

Fatal self-injury in the United States, 1999–2018: Unmasking a national mental health crisis

Background Suicides by any method, plus ‘nonsuicide’ fatalities from drug self-intoxication (estimated from selected forensically undetermined and ‘accidental’ deaths), together represent self-injury mortality (SIM)—fatalities due to mental disorders or distress. SIM is especially important to examine given frequent undercounting of suicides amongst drug overdose deaths. We report suicide and SIM trends in the United States of America (US) during 1999–2018, portray interstate rate trends, and examine spatiotemporal (spacetime) diffusion or spread of the drug self-intoxication component of SIM, with attention to potential for differential suicide misclassification. Methods For this state-based, cross-sectional, panel time series, we used de-identified manner and underlying cause-of-death data for the 50 states and District of Columbia (DC) from CDC's Wide-ranging Online Data for Epidemiologic Research. Procedures comprised joinpoint regression to describe national trends; Spearman's rank-order correlation coefficient to assess interstate SIM and suicide rate congruence; and spacetime hierarchical modelling of the ‘nonsuicide’ SIM component. Findings The national annual average percentage change over the observation period in the SIM rate was 4.3% (95% CI: 3.3%, 5.4%; p6.0% increase (p<0.05). Interpretation Depiction of rising SIM trends across states and major regions unmasks a burgeoning national mental health crisis. Geographic variation is plausibly a partial product of local heterogeneity in toxic drug availability and the quality of medicolegal death investigations. Like COVID-19, the nation will only be able to prevent SIM by responding with collective, comprehensive, systemic approaches. Injury surveillance and prevention, mental health, and societal well-being are poorly served by the continuing segregation of substance use disorders from other mental disorders in clinical medicine and public health practice

Associations among Pain, Non‐Medical Prescription Opioid Use, and Drug Overdose History

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/102230/1/ajad12055.pd

Item Response Theory Analysis of DSM-IV Criteria for Inhalent-Use Disorders in Adolescents

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/78044/1/58.pdf2