Abstract
What's Oxymorphone got to do with it? High Risk Injection Practices Leading to an Outbreak of HIV in a Rural Community
Joan Duwve, MD, MPH1, Carrie Foote, PhD2 and Jeremy Roseberry, MA3
(1)Indiana University, Indianapolis, IN, (2)Indiana University, Indianapolis, Indianapolis, IN, (3)Health Care Education and Training, Inc., Indianapolis, IN
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
Background: In 2015, Indiana experienced a large rural outbreak of HIV associated with injection of prescription extended-release (ER) oxymorphone pills. By February 2016, 190 individuals had been diagnosed with HIV. Drug preparation and injection practices that increase HIV risk among individuals who inject oxymorphone ER in this community are not well understood.
Methods: A qualitative study was conducted July-September, 2015, to identify drug and behavioral factors which may have led to rapid transmission of HIV during this outbreak. Purposeful sampling was conducted through service provider referrals, peer referrals and street recruitment. Four focus groups (N=31) and 25 individual interviews were completed. Interviews were administered using semi-structured interview guides, audio recorded, and transcribed for coding and descriptive thematic analyses.
Results: All participants had experience injecting oxymorphone ER.
Participants described transitioning to oxymorphone ER use after oxycodone was replaced with an abuse-deterrent formulation resistant to crushing, snorting, and dissolving. A subsequent formulary change of oxymorphone ER also prevented crushing and snorting, but not dissolving. This resulted in cooking pills to break down the coating, dissolving, and then injecting the solution as the only way to get high off the pill. Participants reported using multiple draws to accommodate the volume of liquid needed to dissolve the drug. They also reported limited access to sterile syringes and pooling money to purchase pills due to their high street-based cost. This facilitated sharing pill solutions and injection equipment among multiple end-users. Finally, many participants described 2-7 injection episodes per-day with 2-4 injections per-injection episode.
Conclusion: Practices common in this community related to injection of oxymorphone ER incur high risk for rapid HIV transmission among networks of people who inject drugs. Programs working with persons who inject prescription opioids should assess injection practices and provide tailored harm reduction counseling and services to reduce HIV transmission risk.
Epidemiology Protection of the public in relation to communicable diseases including prevention or control Public health or related research Social and behavioral sciences
Abstract
Needs Assessment for Improved Surveillance of Overdose Deaths in Maryland
Meghan Smith, MPH1, Adebola Akinyemi, MPH1, Michael Baier2, Erin Haas, MPH3 and Clifford S. Mitchell, MS, MD, MPH1
(1)Maryland Department of Health and Mental Hygiene, Baltimore, MD, (2)Maryland Department of Health and Mental Hygiene, Catonsville, MD, (3)Maryland Department of Health, Catonsville, MD
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
Issue: Drug overdose is a major contributor to mortality in Maryland. Officially, overdose deaths may be ruled as suicides, accidents, homicides, or “deaths of undetermined intent.” Although these categories are useful from a legal perspective, prevention efforts may benefit from additional analyses to identify commonalities and distinguishing factors among groups.
Description: We conducted a needs assessment to describe the state of overdose data in Maryland and recommend data strategies that would promote risk factor identification and inform prevention across official manner of death categories.
Lessons Learned: Available data sources were identified, including (1) Maryland Vital Statistics records, (2) the Maryland Violent Death Reporting System (MVDRS), and (3) the Maryland Overdose Fatality Review (OFR) database. Vital Statistics contains a comprehensive list of overdose deaths with basic demographic data but no further circumstances. Preliminary analyses showed 213 accidental overdose deaths, 186 overdose suicides, and 1,738 undetermined overdose deaths for 2009-2011. MVDRS, which excludes out of state deaths and includes a small number of deaths from poisonous gas inhalation, contains detailed circumstance data for 224 poisoning suicides and 1,694 undetermined poisoning deaths for the same years, with additional data years pending. OFR, which is meant to complement other data sources, has collected detailed circumstance data on almost 200 accidental and undetermined overdose deaths that occurred from 2013-2015.
Recommendations: Given varying levels of comprehensiveness and detail, it is expected that combining these sources into one comprehensive dataset using consistent methodology will enhance public health surveillance and risk factor identification, enabling improved overdose prevention activities.
Conduct evaluation related to programs, research, and other areas of practice Epidemiology Public health or related research
Abstract
SAMHSA's Partnerships for Success: Addressing health disparities in underage drinking and prescription drug misuse
Elvira Elek, Ph.D.1, Phillip W. Graham, DrPH, MPH2, Chelsea Burfeind, MA3, Nichole Scaglione, Ph.D.2, Belinda Weimer, MA2, Kyle Emery, M.Sc.2 and Thomas Clarke, Ph.D. MPH4
(1)RTI International, Washington, DC, (2)RTI International, Research Triangle Park, NC, (3)RTI International, Durham, NC, (4)Substance Abuse Mental Health Service Administration, Rockville, MD
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
Background: Substance abuse-related health disparities manifest as a stronger impact of substance use rates or consequences on groups of people who have “systematically experienced greater obstacles to health based on their racial or ethnic group; religion; socioeconomic status; gender; age; mental health; cognitive, sensory, or physical disability; sexual orientation or gender identity; geographic location; or other characteristics historically linked to discrimination or exclusion” (Healthy People 2020). Spurred by mandates of the Affordable Care Act (P.L. 111-148), the Substance Abuse and Mental Health Services Administration (SAMHSA) placed an emphasis on evaluating efforts to impact health disparities in prevention by starting with its flagship substance abuse prevention initiative, the Strategic Prevention Framework Partnerships for Success (SPF-PFS).
Methods: SPF-PFS addresses underage drinking, prescription drug misuse, and other substance abuse issues across over 600 subrecipient communities within grantees in 47 states, 8 territories/jurisdictions, 13 tribal organizations, and the District of Columbia. Community subrecipients report on their health disparities related accomplishments for each SPF step through the Community Level Instrument, which also collects intervention implementation information including health disparities related adaptations, population targets and demographics of individuals reached.
Results: The majority of subrecipients identified specific health disparities sub-populations to target; though less than half implemented or adapted interventions specifically for those targets.
Discussion: The presentation highlights some of those interventions and discusses how PFS efforts increase the accessibility and use of substance use prevention for health disparities populations. It contributes significantly in showing how local communities respond to the increased national focus on health disparities.
Conduct evaluation related to programs, research, and other areas of practice Diversity and culture Implementation of health education strategies, interventions and programs
Abstract
Curbing the Opioid Epidemic: An Examination of Federal and State Regulations, Policies and Initiatives to Address Opioid Overuse, Misuse, Abuse and Overdose
Sarah J. Shoemaker, PhD, PharmD1, Douglas McDonald, PhD2 and Sharmini Radakrishnan, PhD2
(1)Abt Associates, Cambridge, MA, (2)Abt Associates, Rockville, MD
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
Background: The non-medical use of prescription opioids has skyrocketed for almost a decade, which has resulted in an increase in overdose admissions to hospitals and drug related mortality as well as calls for increases in specialized treatment programming for opiate addiction. In response, several federal and state agencies have implemented regulations, policies, and initiatives to address the opioid epidemic.
Methods: We conducted a search of federal and state websites to identify regulations, policies and initiatives aimed at curbing opioid overuse, misuse, abuse and overdose. We examined the regulations and policies, as well as the aims, interventions, stakeholders, and outcomes of the various federal and state initiatives to understand the breadth of efforts.
Results: The Administration and Department of Health and Human Services (HHS) have confronted the opioid epidemic and directed resources across HHS agencies. No less, several state-led initiatives have been funded. The efforts have targeted several areas, including: training health professionals, improving prescribing, changing regulations and policies, increasing monitoring of controlled substances, enhancing prescription drug monitoring programs, coordinating care for persons on chronic opioids, expanding use and distribution of naloxone and medication-assisted treatment to reduce overdose and opioid-use disorders. These initiatives have had diverse, sometimes overlapping aims. There have been several regulatory and policy changes at federal and state levels.
Conclusions: There is a tremendous effort on the part of health agencies to address the opioid epidemic, targeting both prescriber and patient behavior. Some appear to be promising, while others' effectiveness is yet to be determined.
Implementation of health education strategies, interventions and programs Other professions or practice related to public health Public health or related laws, regulations, standards, or guidelines Public health or related organizational policy, standards, or other guidelines