Cited by 189Opioid Use Disorder TreatmentSubstance Abuse Treatment and OutcomesHIV, Drug Use, Sexual Risk

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Touchpoints—opportunities to predict and prevent opioid overdose: a cohort study.

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Larochelle, Marc R., Bernstein, Ryan, Bernson, Dana, Land, Thomas, Stopka, Thomas J., Rose, Adam J., Bharel, Monica, Liebschutz, Jane M., Walley, Alexander Y.·2019·Drug and Alcohol Dependence

DOI 10.1016/j.drugalcdep.2019.06.039PMC PMC7020606

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Abstract

Background Medical care, public health, and criminal justice systems encounters could serve as touchpoints to identify and intervene with individuals at high-risk of opioid overdose death. The relative risk of opioid overdose death and proportion of deaths that could be averted at such touchpoints are unknown.Methods We used 8 individually linked data sets from Massachusetts government agencies to perform a retrospective cohort study of Massachusetts residents ages 11 and older. For each month in 2014, we identified past 12-month exposure to 4 opioid prescription touchpoints (high dosage, benzodiazepine co-prescribing, multiple prescribers, or multiple pharmacies) and 4 critical encounter touchpoints (opioid detoxification, nonfatal opioid overdose, injection-related infection, and release from incarceration). The outcome was opioid overdose death. We calculated Standardized Mortality Ratios (SMRs) and Population Attributable Fractions (PAFs) associated with touchpoint exposure.Results The cohort consisted of 6,717,390 person-years of follow-up with 1315 opioid overdose deaths. We identified past 12-month exposure to any touchpoint in 2.7% of person-months and for 51.8% of opioid overdose deaths. Opioid overdose SMRs were 12.6 (95% CI: 11.1, 14.1) for opioid prescription and 68.4 (95% CI: 62.4, 74.5) for critical encounter touchpoints. Fatal opioid overdose PAFs were 0.19 (95% CI: 0.17, 0.21) for opioid prescription and 0.37 (95% CI: 0.34, 0.39) for critical encounter touchpoints.Conclusions Using public health data, we found eight candidate touchpoints were associated with increased risk of fatal opioid overdose, and collectively identified more than half of opioid overdose decedents. These touchpoints are potential targets for development of overdose prevention interventions.

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Friedmann, P. D., Wilson, D., Stopka, T. J., Bernson, D., Pivovarova, E., Ferguson, W. J., Hoskinson, R. A., Rottapel, R. E., Bovell-Ammon, B. J., Gaba, A., et al. (2025) · New England Journal of Medicine · doi:10.1056/nejmsa2415987 · Cited by 25
Northeast Postacute Medical Facilities Disproportionately Reject Referrals For Patients With Opioid Use Disorder
Kimmel, S. D., Rosenmoss, S., Bearnot, B. I., Weinstein, Z., Yan, S., Walley, A. Y., & Larochelle, M. R. (2022) · Health Affairs · doi:10.1377/hlthaff.2021.01242 · Cited by 25
The Future of the United States Overdose Crisis: Challenges and Opportunities
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Rapid Methadone Induction in a General Hospital Setting: A Retrospective, Observational Analysis
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“002 Days to peak dose 3 (2-4) 4 (2-6) 0.”
Adapting Palliative Care Skills to Provide Substance Use Disorder Treatment to Patients With Serious Illness
Jones, K. F., Ho, J. J., Sager, Z. S., Childers, J. W., & Merlin, J. S. (2021) · American Journal of Hospice and Palliative Medicine® · doi:10.1177/1049909121999783 · Cited by 25
“While collaboration with an addiction specialist is important, it is not always available and expanding SUD treatment to non-addiction specialists is a key public health strategy to decrease SUD harms.(3,5,13-15) Lack of confidence of PC clinicians to provide SUD treatment in persons with a serious illness is likely r…”
Background
The Massachusetts Department of Public Health Post Overdose Support Team Initiative: A Public Health–Centered Co-Response Model for Post–Overdose Outreach
Formica, S. W., Reilly, B., Duska, M., Ruiz, S., Lagasse, P., Wheeler, M., Delaney, A., & Walley, A. Y. (2022) · Journal of Public Health Management and Practice · doi:10.1097/phh.0000000000001574 · Cited by 24
Community overdose surveillance: Comparing substances collected from the death scene investigation to toxicology results
Lockwood, T. E., Huynh, P., Richard, A., Sightes, E., Bailey, K., Ray, B. R., & Lieberman, M. (2021) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2021.108722 · Cited by 23
The impact of opioid agonist treatment on fatal and non-fatal drug overdose among people with a history of opioid dependence in NSW, Australia, 2001–2018: Findings from the OATS retrospective linkage study
Jones, N. R., Hickman, M., Nielsen, S., Larney, S., Dobbins, T., Ali, R. L., & Degenhardt, L. J. (2022) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2022.109464 · Cited by 21
Does incarceration influence patients’ goals for opioid use disorder treatment? A qualitative study of buprenorphine treatment in jail
Vail, W. L., Faro, E. Z., Watnick, D. L., Giftos, J., & Fox, A. D. (2021) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2021.108529 · Cited by 22
The role of law enforcement officers in responding to the opioid epidemic: A qualitative assessment
Pike, E., Tillson, M. D., Staton, M., & Webster, J. M. (2021) · Substance Abuse · doi:10.1080/08897077.2020.1865243 · Cited by 21
“One study showed that individuals who experienced a non-fatal overdose, injection-related infection, opioid detox, or release from incarceration had a 68-fold increase in experiencing a fatal opioid overdose.(20) Each of these service delivery encounters could be an opportunity to intervene with individuals who misuse…”
Background
Factors associated with opioid-involved overdose among previously incarcerated people in the U.S.: A community engaged narrative review
Flam-Ross, J. M., Lown, J., Patil, P., White, L. F., Wang, J., Perry, A. M., Bailer, D., McKenzie, M., Thigpen, A., Newman, R., et al. (2021) · International Journal of Drug Policy · doi:10.1016/j.drugpo.2021.103534 · Cited by 19
Resident Communication With Patients and Families Preferring Languages Other Than English
Rojas, C. R., Coffin, A., Taylor, A., Ortiz, P. N., Jenicek, G., Hart, J. K., Callahan, J. M., & Shaw, K. N. (2023) · Hospital Pediatrics · doi:10.1542/hpeds.2022-007003 · Cited by 18
Approaches to opioid prescribing in cancer survivors: Lessons learned from the general literature
Jones, K. F., & Merlin, J. S. (2021) · Cancer · doi:10.1002/cncr.33961 · Cited by 18
“The observed characteristics are critically important because they represent highrisk opioid prescribing features, including an elevated risk for opioidrelated harms and unintended opioid overdose.(2) This study is part of a growing body of literature describing opioid continuation for more than a year beyond the init…”
Background
Defining “Doctor Shopping” with Dispensing Data: A Scoping Review
Delcher, C., Bae, J., Wang, Y., Doung, M., Fink, D. S., & Young, H. W. (2021) · Pain Medicine · doi:10.1093/pm/pnab344 · Cited by 17
“The most frequently studied states included California (n1⁄4 11) [23, 51, 57, 60, 61, 88, 90, 91, 103, 112, 113], Oregon (n1⁄4 7) [27, 70, 82, 84, 85, 99, 100], New York (n1⁄4 6) [41, 67, 68, 78, 90, 96], and Massachusetts (n1⁄4 6) [48, 49, 76, 86, 89, 96].”
Frame Shift: Focusing on Harm Reduction and Shared Decision Making for People Who Use Drugs Hospitalized With Infections
Thakarar, K., Appa, A. A., Abdul‐Mutakabbir, J. C., Goff, A., Brown, J. A., Tuell, C., Fairfield, K. M., & Wurcel, A. G. (2023) · Clinical Infectious Diseases · doi:10.1093/cid/ciad664 · Cited by 17
Predicting overdose among individuals prescribed opioids using routinely collected healthcare utilization data
Sun, J. W., Franklin, J. M., Rough, K., Desai, R. J., Hernández–Dı́az, S., Huybrechts, K. F., & Bateman, B. T. (2020) · PLoS ONE · doi:10.1371/journal.pone.0241083 · Cited by 17
“Another limitation is that the list of candidate predictors does not encompass all of the important risk factors of overdose, such as behavioral health and criminal justice variables that are poorly captured in claims data [42].”
Background
“Doctor and pharmacy shopping”: A fading signal for prescription opioid use monitoring?
Delcher, C., Harris, D. R., Park, C., Strickler, G. K., Talbert, J., & Freeman, P. R. (2021) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2021.108618 · Cited by 17
Mortality risk and causes of death among people who use opioids in a take-home naloxone cohort
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Implementation and maintenance of an emergency department naloxone distribution and peer recovery specialist program
Jacka, B. P., Ziobrowski, H. N., Lawrence, A. C., Baird, J. B., Wentz, A. E., Marshall, B. D. L., Wightman, R., Mello, M. J., Beaudoin, F. L., & Samuels, E. A. (2021) · Academic Emergency Medicine · doi:10.1111/acem.14409 · Cited by 16
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Doogan, N., Mack, A., Wang, J., Crane, D. A., Jackson, R. D., Applegate, M., Villani, J., Chandler, R. K., & Barocas, J. A. (2022) · American Journal of Epidemiology · doi:10.1093/aje/kwac154 · Cited by 16
A cross-sectional study of factors associated with COVID-19 testing among people who inject drugs: missed opportunities for reaching those most at risk
Yeager, S., Abramovitz, D. A., Vera, A., Vera, C. F., Algarin, A. B., Smith, L. R., Rangel, G., Artamónova, I., Patterson, T. L., Bazzi, A. R., et al. (2022) · BMC Public Health · doi:10.1186/s12889-022-13273-y · Cited by 16
“We identified correlates of COVID-19 testing and described interactions with services or venues where COVID-19 testing could have been offered, drawing from literature on overdose prevention ‘touchpoints’ within the healthcare system [29].”
BackgroundMethod
Medication for Opioid Use Disorder After Serious Injection-Related Infections in Massachusetts
Kimmel, S. D., Walley, A. Y., White, L. F., Yan, S., Grella, C. E., Majeski, A., Stein, M. D., Bettano, A. L., Bernson, D., Drainoni, M., et al. (2024) · JAMA Network Open · doi:10.1001/jamanetworkopen.2024.21740 · Cited by 15
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“Studies have found that individuals hospitalized for injection-related infection were at a higher risk of readmission, recurrent infection, overdose, and death after discharge.(3,4) Such findings have sparked an investigation of the causes of poor outcomes amongst hospitalized populations of PWUD.”
Background
Court-Mandated Treatment Outcomes for Prescribed Opioid Use Disorder: A Gender Based Study
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“The United Sates faces a surge in deaths by overdose for individuals with OUD (Larochelle et al., 2019).”
Background
Pharmacy leaders’ beliefs about how pharmacies can support a sustainable approach to providing naloxone to the community
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(2021) · Springer eBooks · doi:10.1007/978-3-030-80818-1 · Cited by 13
Racial disparities in criminal legal system involvement among New York City overdose decedents: Implications for diversion programs
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Exemplar Hospital initiation trial to Enhance Treatment Engagement (EXHIT ENTRE): protocol for CTN-0098B a randomized implementation study to support hospitals in caring for patients with opioid use disorder
Bart, G. B., Korthuis, P. T., Donohue, J. M., Hagedorn, H., Gustafson, D., Bazzi, A. R., Enns, E. A., McNeely, J., Ghitza, U. E., Magane, K. M., et al. (2024) · Addiction Science & Clinical Practice · doi:10.1186/s13722-024-00455-9 · Cited by 11
“…of un-or under-treated OUD, withdrawal, and craving, patients often leave before medically advised (i.e., against medical advice), not completing treatment for the acute condition for which they were hospitalized, return to opioid use, and are at increased risk for opioid overdose death [10–12].”
Background
Unintentional Opioid Overdose Death Characteristics in Illinois Before and During the COVID-19 Era, 2017 to 2020
Kim, H. S., Feinglass, J. M., McCarthy, D. M., Lank, P. M., & Mason, M. (2021) · JAMA Health Forum · doi:10.1001/jamahealthforum.2021.3699 · Cited by 12
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Ray, B. R., Christian, K., Bailey, T., Alton, M., Proctor, A., Haggerty, J., Lowder, E. M., & Aalsma, M. C. (2023) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2023.109891 · Cited by 15
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Shearer, R. D., Hagedorn, H., Englander, H. L., Siegler, T., Kibben, R., Fawole, A., Patten, A., Fitzpatrick, A., Laes, J. R., Fernando, J., et al. (2024) · Journal of Substance Use and Addiction Treatment · doi:10.1016/j.josat.2024.209520 · Cited by 11
“Inpatient hospital admissions among individuals with OUD are common (Gryczynski et al., 2016), and represent an opportunity to engage patients in MOUD treatment (Larochelle et al., 2019; Liebschutz et al., 2014).”
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“Correctional facilities pre-sent clinical and public health intervention touch points for the prevention and treatment of OUD and opioid-related overdoses [7].”
Background
Disruptions to HIV Prevention During Armed Conflict in Ukraine and Other Settings
Nikitin, B. M., Bromberg, D. J., Ivasiy, R., Madden, L. M., Machavariani, E., Дворяк, С., Poole, D. N., Otiashvili, D., & Altice, F. L. (2024) · Current HIV/AIDS Reports · doi:10.1007/s11904-024-00716-x · Cited by 11
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Missed opportunities: Arrest and court touchpoints for individuals who fatally overdosed in Philadelphia in 2016
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Initiatives to Support the Transition of Patients With Substance Use Disorders From Acute Care to Community-based Services Among a National Sample of Nonprofit Hospitals
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Reachable Moment: Hospital-Based Interventions
Weinstein, Z., & Englander, H. L. (2021) · Springer eBooks · doi:10.1007/978-3-030-80818-1_4 · Cited by 10
Addiction Consult Services, Mortality, and Acute Care Utilization in Inpatients With Opioid Use Disorder
Abadi, Y. R., Wang, S., King, C., Marcello, R. K., Wye, G. V., Tuazon, E. D., Kennedy, J., Cooke, C., Mazumdar, M., Tarpey, T., et al. (2025) · JAMA Network Open · doi:10.1001/jamanetworkopen.2025.25222 · Cited by 11
Variation in emergency department visit rates for opioid use disorder: Implications for quality improvement initiatives
Khatri, U. G., Samuels, E. A., Xiong, R. A., Marshall, B. D. L., Perrone, J., & Delgado, M. K. (2021) · The American Journal of Emergency Medicine · doi:10.1016/j.ajem.2021.10.047 · Cited by 10
Older adult drug overdose: an application of latent class analysis to identify prevention opportunities
Mason, M., Pandya, K., & Lundberg, A. L. (2024) · Harm Reduction Journal · doi:10.1186/s12954-024-00973-4 · Cited by 12
Opioid Use Disorder in Older Adults: a Narrative Review
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“Older adults with OUD are interacting with the healthcare system, creating touchpoints for evidence-based interventions [51].”
Characteristics of post-overdose outreach programs and municipal-level opioid overdose in Massachusetts
Kimmel, S. D., Xuan, Z., Yan, S., Lambert, A. M., Formica, S. W., Green, T. C., Carroll, J. J., Bagley, S. M., Rosenbloom, D., Beletsky, L. A., et al. (2023) · International Journal of Drug Policy · doi:10.1016/j.drugpo.2023.104164 · Cited by 10
Claims-based measures of prescription opioid utilization: A practical guide for researchers
Heins, S. E., Buttorff, C., Armstrong, C., & Pacula, R. L. (2021) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2021.109087 · Cited by 9
CommunityStat: A Public Health Intervention to Reduce Opioid Overdose Deaths in Burlington, Vermont, 2017–2020
del Pozo, B. (2021) · Contemporary Drug Problems · doi:10.1177/00914509211052107 · Cited by 9
“City officials concluded that linking people at risk of overdose to effective care through a wide range of touchpoints was critical (Larochelle et al., 2019), and an investment in increasing access to these medications was necessary (Saloner & Barry, 2018).”
Background
Simulating the impact of Addiction Consult Services in the context of drug supply contamination, hospitalizations, and drug-related mortality
King, C. A., Cook, R., Wheelock, H., Korthuis, P. T., Leahy, J. M., Goff, A., Morris, C. D., & Englander, H. L. (2021) · International Journal of Drug Policy · doi:10.1016/j.drugpo.2021.103525 · Cited by 9
Jail Characteristics and Availability of Opioid Treatment Services: Results from a Nationally Representative Survey
Kopak, A. M., & Thomas, S. D. (2024) · The Journal of Behavioral Health Services & Research · doi:10.1007/s11414-024-09881-8 · Cited by 8
Feasibility and Safety of a Paramedic-Directed Prehospital Buprenorphine Initiation Protocol for Acute Opioid Withdrawal
Simpson, N. S., Kummer, T. M., Drone, H. M., Perlmutter, M. C., Schin, A. M., Cole, J. B., Driver, B. E., Puskarich, M. A., Martin, M. E., Bunting, A. J., et al. (2024) · Prehospital Emergency Care · doi:10.1080/10903127.2024.2422897 · Cited by 8
Hospital Provider’s Perspectives on MOUD Initiation and Continuation After Inpatient Discharge
Shearer, R. D., Englander, H. L., Hagedorn, H., Fawole, A., Laes, J. R., Titus, H. E., Patten, A., Oot, E. N., Appleton, N., Fitzpatrick, A., et al. (2024) · Journal of General Internal Medicine · doi:10.1007/s11606-024-09008-x · Cited by 8
“2,3 Numerous studies show that both buprenorphine and methadone can be successfully initiated in the hospital setting.”

Authors: Larochelle, M. R., Bernstein, R., Bernson, D., Land, T., Stopka, T. J., Rose, A. J., Bharel, M., Liebschutz, J. M., & Walley, A. Y.
Affiliations: Boston University (US)
Massachusetts Department of Public Health (US)
University of Massachusetts Chan Medical School (US)
Tufts University (US)
RAND Corporation (US)
University of Pittsburgh (US)
Corresponding author: Larochelle, Marc R.
ORCID: Larochelle, Marc R.
Bernson, Dana
Stopka, Thomas J.
Rose, Adam J.
Liebschutz, Jane M.
Walley, Alexander Y.
Venue: Drug and Alcohol Dependence
Publisher: Elsevier BV
Published: 2019-11
Volume: 204
Pages: 107537
ISSN: 0376-8716 (ISSN-L)
DOI: 10.1016/j.drugalcdep.2019.06.039
PMC: PMC7020606
OpenAlex: W2971555090
Cited by: 189
References: 52
Citations by year: 2026: 20 · 2025: 21 · 2024: 36 · 2023: 25 · 2022: 23 · 2021: 47 · 2020: 16 · 2019: 1
FWCI: 20.03
Type: journal article
Language: en
Open access: green
www.ncbi.nlm.nih.gov
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
www.elsevier.com/legal/tdmrep-license (tdm)
Locations: Drug and Alcohol Dependence (publishedVersion)
PubMed (publishedVersion)
PubMed Central (acceptedVersion)
Funders: School of Medicine, Boston University
National Institute on Drug Abuse
Topics: Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Opioid Use Disorder Treatment
Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
Health Sciences › Medicine › Epidemiology › HIV, Drug Use, Sexual Risk
Keywords: opioid overdose, overdose prevention, touchpoints, opioid prescribing, multiple prescribers, opioid detoxification, injection-related infections, incarceration, drug overdose deaths, population attributable fraction, standardized mortality ratio
MeSH terms: Adolescent, Adult, Analgesics, Opioid, Child, Criminal Law, Female, Forecasting, Humans, Male, Massachusetts, Middle Aged, Opioid-Related Disorders, Patient Acceptance of Health Care, Drug Prescriptions, Retrospective Studies, Risk, Young Adult, Drug Overdose

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Touchpoints—opportunities to predict and prevent opioid overdose: a cohort study.

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