66 research outputs found
Drug Overdose: New Insights, Innovative Surveillance, and Promising Interventions
Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/40354/2/Galea_Drug Overdose - New Insights, Innovative Surveillance_2003.pd
Identifying Injection Drug Users at Risk of Nonfatal Overdose
Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/75145/1/j.1553-2712.2007.tb01846.x.pd
Preliminary Evidence of Health Care Provider Support for Naloxone Prescription as Overdose Fatality Prevention Strategy in New York City
Preliminary research suggests that naloxone (Narcan), a short-acting opiate
antagonist, could be provided by prescription or distribution to heroin users to reduce
the likelihood of fatality from overdose. We conducted a random postal survey of
1,100 prescription-authorized health care providers in New York City to determine
willingness to prescribe naloxone to patients at risk of an opiate overdose. Among
363 nurse practitioners, physicians, and physician assistants responding, 33.4% would
consider prescribing naloxone, and 29.4% were unsure. This preliminary study suggests
that a substantial number of New York City health care providers would prescribe
naloxone for opiate overdose prevention.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/40255/2/Coffin_Preliminary Evidence of Health Care Provider_2003.pd
Circumstances of Witnessed Drug Overdose in New York City: Implications for Intervention
Drug users frequently witness the nonfatal and fatal drug overdoses of their peers, but often fail to intervene effectively to reduce morbidity
and mortality.We assessed the circumstances of witnessed heroin-related overdoses in NewYork City (NYC) among a predominantly minority
population of drug users. Among 1184 heroin, crack, and cocaine users interviewed between November 2001 and February 2004, 672 (56.8%)
had witnessed at least one nonfatal or fatal heroin-related overdose. Of those, 444 (67.7%) reported that they or someone else present called
for medical help for the overdose victim at the last witnessed overdose. In multivariable models, the respondent never having had an overdose
her/himself and the witnessed overdose occurring in a public place were associated with the likelihood of calling for medical help. Fear of
police responsewas the most commonly cited reason for not calling or delaying before calling for help (52.2%). Attempts to revive the overdose
victim through physical stimulation (e.g., applying ice, causing pain) were reported by 59.7% of respondents, while first aid measures were
attempted in only 11.9% of events. Efforts to equip drug users to manage overdoses effectively, including training in first aid and the provision
of naloxone, and the reduction of police involvement at overdose events may have a substantial impact on overdose-related morbidity and
mortality.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/40301/2/Tracy_Circumstances of Witnessed Drug Overdose in_2005.pd
Racial/Ethnic Disparities in Overdose Mortality Trends in New York City, 1990-1998
Racial/ethnic disparities in health and disease have been present in the United
States for the past century. Although differences such as individual access to health
care and health-related behaviors account for some of these health disparities, it is
likely that a combination of individual and contextual-level factors determine the differential
rates of disease between racial/ethnic groups. We studied fatal accidental drug
overdose in New York City between 1990 and 1998 to describe differences in racial/
ethnic patterns over time and to develop hypotheses about factors that might contribute
to these differences. During this period, rates of overdose death were consistently
higher among blacks and Latinos compared to whites. In addition, cocaine was more
common among black decedents, while opiates and alcohol were more common among
Latino and white decedents. Differences in situational factors, such as differential likelihood
of activating emergency medical response, may in part explain the consistently
higher overdose mortality rates observed among minorities. Further study to determine
the individual and contextual factors that explain these observed disparities in overdose
death may identify effective areas for public health intervention and provide insight
into factors underlying racial/ethnic disparities in other health outcomes.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/40333/2/Galea_Racial-Ethnic Disparities in Overdose Mortality_2003.pd
Income distribution and risk of fatal drug overdose in New York City neighborhoods
Accidental drug overdose is a substantial cause of mortality for drug users. Neighborhood-level factors, such as income
distribution, may be important determinants of overdose death independent of individual-level factors. We used data from the
Office of the Chief Medical Examiner to identify all cases of accidental deaths in New York City (NYC) in 1996 and individual-level
covariates. We used 1990 US Census data to calculate the neighborhood-level income distribution. This multi-level case /control
study included 725 accidental overdose deaths (cases) and 453 accidental deaths due to other causes (controls) in 59 neighborhoods
in NYC. Overdose deaths were more likely in neighborhoods with higher levels of drug use and with more unequal income
distribution. In multi-level models, income maldistribution was significantly associated with risk of overdose independent of
individual-level variables (age, race, and sex) and neighborhood-level variables (income, drug use, and racial composition). The odds
of death due to drug overdose were 1.63 - 1.88 in neighborhoods in the least equitable decile compared with neighborhoods in the
most equitable decile. Disinvestment in social and economic resources in unequal neighborhoods may explain this association.
Public health interventions related to overdose risk should pay particular attention to highly unequal neighborhoods.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/40348/2/Galea_Income Distribution and Risk of Fatal Drug_2003.pd
Patient acceptance of universal screening for hepatitis C virus infection
<p>Abstract</p> <p>Background</p> <p>In the United States, about 70% of 2.9-3.7 million people with hepatitis C (HCV) are unaware of their infection. Although universal screening might be a cost-effective way to identify infections, prevent morbidity, and reduce transmission, few efforts have been made to determine patient opinions about new approaches to screening.</p> <p>Methods</p> <p>We surveyed 200 patients in August 2010 at five outpatient clinics of a major public urban medical center in Seattle, WA, with an 85.8% response rate.</p> <p>Results</p> <p>The sample was 55.3% women, median 47 years of age, and 56.3% white and 32.7% African or African-American; 9.5% and 2.5% reported testing positive for HCV and HIV, respectively. The vast majority of patients supported universal screening for HCV. When presented with three options for screening, 48% preferred universal testing without being informed that they were being tested or provided with negative results, 37% preferred testing with the chance to "opt-out" of being tested and without being provided with negative results, and 15% preferred testing based on clinician judgment. Results were similar for HIV screening.</p> <p>Conclusions</p> <p>Patients support universal screening for HCV, even if that screening involves testing without prior consent or the routine provision of negative test results. Current screening guidelines and procedures should be reconsidered in light of patient priorities.</p
Extended-release naltrexone for methamphetamine dependence among men who have sex with men: a randomized placebo-controlled trial.
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