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Touchpoints—opportunities to predict and prevent opioid overdose: a cohort study.
Open accessAbstract
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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“Hospitalizations are critical opportunities to engage patients who are at high risk for overdose to prevent future overdoses, as hospital addiction care with referral to treatment increases outpatient SUD treatment engagement.19,20”
From Assessment of Annual Cost of Substance Use Disorder in US Hospitals (2021) · cites this paper as [20]
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Cites
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BackgroundOpioid Prescriptions for Chronic Pain and Overdose
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BackgroundEmergency Department–Initiated Buprenorphine/Naloxone Treatment for Opioid Dependence
D’Onofrio, G., O’Connor, P. G., Pantalon, M. V., Chawarski, M. C., Busch, S. H., Owens, P. H., Bernstein, S. L., & Fiellin, D. A. (2015) · JAMA · doi:10.1001/jama.2015.3474 · Cited by 913
Meta‐analysis of drug‐related deaths soon after release from prison
Merrall, E. L. C., Kariminia, A., Binswanger, I. A., HOBBS, M. S. T., Farrell, M., Marsden, J., Hutchinson, S. J., & Bird, S. M. (2010) · Addiction · doi:10.1111/j.1360-0443.2010.02990.x · Cited by 689 · cited 1×
“the risk of opioid overdose death (Binswanger et al., 2013; Caudarella et al., 2016; Darke et al., 2011; Larochelle et al., 2018; Merrall et al., 2010).”
Binswanger, I. A., Blatchford, P. J., Mueller, S. R., & Stern, M. F. (2013) · Annals of Internal Medicine · doi:10.7326/0003-4819-159-9-201311050-00005 · Cited by 598 · cited 3×
“A uthor M anuscript A uthor M anuscript A uthor M anuscript A uthor M anuscript the risk of opioid overdose death (Binswanger et al., 2013; Caudarella et al., 2016; Darke et al., 2011; Larochelle et al., 2018; Merrall et al., 2010).”
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“Naloxone distribution programs and treatment with medications for opioid use disorder (MOUD) are associated with reduced opioid overdose mortality (McDonald and Strang, 2016; Sordo et al., 2017; Walley et al., 2013).”
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“…arise when persons who use opioids seek short-term inpatient detoxification, or seek care for complications related to opioid use, such as injection-related infections (Bailey et al., 2013; Davoli et al., 2007; Kim et al., 2016; Ronan and Herzig, 2016; Rosenthal et al., 2016; Stein et al., 2017).”
BackgroundBuprenorphine Treatment for Hospitalized, Opioid-Dependent Patients
Liebschutz, J. M., Crooks, D., Herman, D. S., Anderson, B. J., Tsui, J. I., Meshesha, L. Z., Dossabhoy, S. S., & Stein, M. D. (2014) · JAMA Internal Medicine · doi:10.1001/jamainternmed.2014.2556 · Cited by 342 · cited 1×
“Though not currently widely accessible, buprenorphine initiation within emergency department and inpatient hospitals has been demonstrated to be feasible, to increase linkage to addiction treatment and to reduce illicit opioid use (D’Onofrio et al., 2017, 2015; Liebschutz et al., 2014).”
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Green, T. C., Clarke, J. G., Brinkley‐Rubinstein, L., Marshall, B. D. L., Alexander-Scott, N. E., Boss, R., & Rich, J. D. (2018) · JAMA Psychiatry · doi:10.1001/jamapsychiatry.2017.4614 · Cited by 321 · cited 1×
“More specifically, studies among overdose survivors and individuals released from incarceration have shown MOUD are associated with reduced opioid overdose death yet a minority receive them (Green et al., 2018; Larochelle et al., 2018).”
BackgroundFrank, J. W., Lovejoy, T. I., Becker, W. C., Morasco, B. J., Koenig, C. J., Hoffecker, L., Dischinger, H. R., Dobscha, S. K., & Krebs, E. E. (2017) · Annals of Internal Medicine · doi:10.7326/m17-0598 · Cited by 318 · cited 1×
“A systematic review suggested opioid tapering may improve patient outcomes; however, evidence quality was low and most studies were limited to individuals interested in tapering (Frank et al., 2017).”
BackgroundCharacteristics of Fentanyl Overdose — Massachusetts, 2014–2016
Somerville, N. J., O’Donnell, J. K., Gladden, R. M., Zibbell, J. E., Green, T. C., Younkin, M., Ruiz, S., Babakhanlou‐Chase, H., Chan, M., Callis, B. P., et al. (2017) · MMWR Morbidity and Mortality Weekly Report · doi:10.15585/mmwr.mm6614a2 · Cited by 294
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“Opportunities also arise when persons who use opioids seek short-term inpatient detoxification, or seek care for complications related to opioid use, such as injection-related infections (Bailey et al., 2013; Davoli et al., 2007; Kim et al., 2016; Ronan and Herzig, 2016; Rosenthal et al., 2016; Stein et al., 2017).”
BackgroundD’Onofrio, G., Chawarski, M. C., O’Connor, P. G., Pantalon, M. V., Busch, S. H., Owens, P. H., Hawk, K. F., Bernstein, S. L., & Fiellin, D. A. (2017) · Journal of General Internal Medicine · doi:10.1007/s11606-017-3993-2 · Cited by 260
Non-fatal overdose as a risk factor for subsequent fatal overdose among people who inject drugs
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“the risk of opioid overdose death (Binswanger et al., 2013; Caudarella et al., 2016; Darke et al., 2011; Larochelle et al., 2018; Merrall et al., 2010).”
High-Risk Use by Patients Prescribed Opioids for Pain and Its Role in Overdose Deaths
Baumblatt, J. A. G., Wiedeman, C., Dunn, J. R., Schaffner, W., Paulozzi, L. J., & Jones, T. F. (2014) · JAMA Internal Medicine · doi:10.1001/jamainternmed.2013.12711 · Cited by 252 · cited 3×
“Known opioid prescription touchpoints associated with increased risk of fatal opioid overdose include high opioid dosage, co-prescribing opioids and benzodiazepines, and receiving or filling opioid prescriptions from multiple providers or pharmacies (Baumblatt et al., 2014; Bohnert et al., 2011; Dunn et al., 2010; Gar…”
BackgroundAddiction consultation services – Linking hospitalized patients to outpatient addiction treatment
Trowbridge, P., Weinstein, Z., Kerensky, T., Roy, P. J., Regan, D., Samet, J. H., & Walley, A. Y. (2017) · Journal of Substance Abuse Treatment · doi:10.1016/j.jsat.2017.05.007 · Cited by 242 · cited 1×
“An evaluation of one program demonstrated feasibility in initiating MOUD with successful linkage to post-discharge care, and a pragmatic multi-site trial of inpatient addiction consult services is underway (McNeely et al., 2019; Trowbridge et al., 2017).”
BackgroundDavoli, M., Bargagli, A. M., Perucci, C. A., Schifano, P., Belleudi, V., Hickman, M., Salamina, G., Diecidue, R., Vigna‐Taglianti, F., Faggiano, F., et al. (2007) · Addiction · doi:10.1111/j.1360-0443.2007.02025.x · Cited by 220
Sources of Prescription Opioid Pain Relievers by Frequency of Past-Year Nonmedical Use
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Mandatory Use of Prescription Drug Monitoring Programs
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“The development and implementation of prescription monitoring programs and safer opioid prescribing guidelines are efforts to identify and reduce high-risk opioid prescribing (Dowell et al., 2016; Haffajee et al., 2015).”
BackgroundPatterns of Opioid Use and Risk of Opioid Overdose Death Among Medicaid Patients
Garg, R. K., Fulton‐Kehoe, D., & Franklin, G. M. (2017) · Medical Care · doi:10.1097/mlr.0000000000000738 · Cited by 159 · cited 1×
“Known opioid prescription touchpoints associated with increased risk of fatal opioid overdose include high opioid dosage, co-prescribing opioids and benzodiazepines, and receiving or filling opioid prescriptions from multiple providers or pharmacies (Baumblatt et al., 2014; Bohnert et al., 2011; Dunn et al., 2010; Gar…”
BackgroundOpioid Education and Nasal Naloxone Rescue Kits in the Emergency Department
Dwyer, K. H., Walley, A. Y., Langlois, B. K., Mitchell, P. M., Nelson, K. P., Cromwell, J. W., & Bernstein, E. (2015) · Western Journal of Emergency Medicine · doi:10.5811/westjem.2015.2.24909 · Cited by 148 · cited 1×
“Emergency department based opioid overdose prevention education and naloxone distribution to high-risk individuals has been shown to be feasible (Dwyer et al., 2015).”
BackgroundSurgical outcomes of infective endocarditis among intravenous drug users
Kim, J. B., Ejiofor, J. I., Yammine, M. B., Ando, M., Camuso, J. M., Youngster, I., Nelson, S. B., Kim, A. Y., Melnitchouk, S. I., Rawn, J. D., et al. (2016) · Journal of Thoracic and Cardiovascular Surgery · doi:10.1016/j.jtcvs.2016.02.072 · Cited by 146
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“We stratified into two age categories (11–49 years and > 50 years) to minimize suppression due to small cell sizes and because of data suggesting increasing rates of prescription opioidrelated events and decreasing rates of heroin-related events after age 50 (Unick and Ciccarone, 2017).”
MethodCauses of Death After Nonfatal Opioid Overdose
Olfson, M., Crystal, S., Wall, M., Wang, S., Liu, S.-M., & Blanco, C. (2018) · JAMA Psychiatry · doi:10.1001/jamapsychiatry.2018.1471 · Cited by 121 · cited 1×
“1, similar to our finding of an SMR of 111 (Olfson et al., 2018).”
ResultGreen, C. A., Perrin, N., Janoff, S. L., Campbell, C. I., Chilcoat, H. D., & COPLAN, P. M. (2017) · Pharmacoepidemiology and Drug Safety · doi:10.1002/pds.4157 · Cited by 120 · cited 3×
“A potential “injection-related infection” was identified as an emergency department, observation, or inpatient discharge with a diagnosis for infectious endocarditis, osteomyelitis, or skin-soft tissue infection, among individuals with evidence of injection drug use in the same or prior 12 months via a diagnosis of he…”
BackgroundInfluentialDarke, S. G., Mills, K. L., Ross, J. E., & Teesson, M. (2010) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2010.10.021 · Cited by 113
Uebelacker, L. A., Bailey, G. L., Herman, D. S., Anderson, B. J., & Stein, M. D. (2016) · Journal of Substance Abuse Treatment · doi:10.1016/j.jsat.2016.02.009 · Cited by 110 · cited 2×
“A uthor M anuscript A uthor M anuscript A uthor M anuscript A uthor M anuscript associated infections, 43–78% of inpatient detoxification clients indicated a preference for engagement with MOUD following detoxification (Bailey et al., 2013; Stein et al., 2015, 2017; Uebelacker et al., 2016).”
BackgroundPriest, K. C., & McCarty, D. W. (2019) · Journal of Addiction Medicine · doi:10.1097/adm.0000000000000496 · Cited by 109 · cited 1×
“Inpatient addiction consult services are increasingly being deployed to engage individuals with OUD while hospitalized (Priest and McCarty, 2019).”
BackgroundJeffery, M. M., Hooten, W. M., Henk, H. J., Bellolio, F., Hess, E. P., Meara, E. R., Ross, J. S., & Shah, N. D. (2018) · BMJ · doi:10.1136/bmj.k2833 · Cited by 94
Formica, S. W., Apsler, R., Wilkins, L. E., Ruiz, S., Reilly, B., & Walley, A. Y. (2018) · International Journal of Drug Policy · doi:10.1016/j.drugpo.2018.01.001 · Cited by 92 · cited 1×
“Public health and public safety agencies are increasingly deploying post-overdose outreach programs to engage opioid overdose survivors with varied approaches (Formica et al., 2018).”
BackgroundBailey, G. L., Herman, D. S., & Stein, M. D. (2013) · Journal of Substance Abuse Treatment · doi:10.1016/j.jsat.2013.04.002 · Cited by 74 · cited 2×
“Opportunities also arise when persons who use opioids seek short-term inpatient detoxification, or seek care for complications related to opioid use, such as injection-related infections (Bailey et al., 2013; Davoli et al., 2007; Kim et al., 2016; Ronan and Herzig, 2016; Rosenthal et al., 2016; Stein et al., 2017).”
BackgroundPotentially Inappropriate Opioid Prescribing, Overdose, and Mortality in Massachusetts, 2011–2015
Rose, A. J., Bernson, D., Chui, K. K. H., Land, T. G., Walley, A. Y., Larochelle, M. R., Stein, B. D., & Stopka, T. J. (2018) · Journal of General Internal Medicine · doi:10.1007/s11606-018-4532-5 · Cited by 66 · cited 2×
“…opioid overdose include high opioid dosage, co-prescribing opioids and benzodiazepines, and receiving or filling opioid prescriptions from multiple providers or pharmacies (Baumblatt et al., 2014; Bohnert et al., 2011; Dunn et al., 2010; Garg et al., 2017; Park et al., 2015; Rose et al., 2018).”
BackgroundValidation of an Algorithm to Identify Infective Endocarditis in People Who Inject Drugs
Ball, L. J., Sherazi, A., Laczko, D., Gupta, K., Koivu, S. L., Weir, M. A., Mele, T. S., Tirona, R. G., McCormick, J. K., & Silverman, M. (2017) · Medical Care · doi:10.1097/mlr.0000000000000838 · Cited by 48 · cited 1×
“A validation study found inclusion of hepatitis C diagnosis improved the sensitivity and specificity of an algorithm to identify inpatient cases of drug injection-related endocarditis (Ball et al., 2017).”
MethodMcNeely, J., Troxel, A. B., Kunins, H. V., Shelley, D., Lee, J. D., Walley, A. Y., Weinstein, Z., Billings, J., Davis, N. J., Marcello, R. K., et al. (2019) · Addiction Science & Clinical Practice · doi:10.1186/s13722-019-0135-7 · Cited by 42 · cited 1×
“An evaluation of one program demonstrated feasibility in initiating MOUD with successful linkage to post-discharge care, and a pragmatic multi-site trial of inpatient addiction consult services is underway (McNeely et al., 2019; Trowbridge et al., 2017).”
BackgroundA statewide evaluation of seven strategies to reduce opioid overdose in North Carolina
Alexandridis, A. A., McCort, A. D., Ringwalt, C. L., Sachdeva, N., Sanford, C., Marshall, S. W., Mack, K. A., & Dasgupta, N. (2017) · Injury Prevention · doi:10.1136/injuryprev-2017-042396 · Cited by 38
Preferences for Aftercare Among Persons Seeking Short-Term Opioid Detoxification
Stein, M. D., Anderson, B. J., & Bailey, G. L. (2015) · Journal of Substance Abuse Treatment · doi:10.1016/j.jsat.2015.07.002 · Cited by 34
Emergency department utilization and subsequent prescription drug overdose death
Brady, J. E., DiMaggio, C. J., Keyes, K. M., Doyle, J., Richardson, L. D., & Li, G. (2015) · Annals of Epidemiology · doi:10.1016/j.annepidem.2015.03.018 · Cited by 33 · cited 1×
“Other studies have successfully identified high rates of emergency department and other acute care utilization for individuals prior to opioid overdose death (Brady et al., 2015; Maeng et al., 2017).”
BackgroundThe U.S. opioid epidemic: One disease, diverging tales
McBain, R. K., Rose, A. J., & Larochelle, M. R. (2018) · Preventive Medicine · doi:10.1016/j.ypmed.2018.04.023 · Cited by 24 · cited 1×
“This is consistent with national data showing that overdose deaths due to prescription opioids are more prevalent in older adults, and heroin and fentanyl more prevalent among younger adults (McBain et al., 2018).”
ResultMaeng, D. D., Han, J., Fitzpatrick, M. H., & Boscarino, J. A. (2017) · Substance Abuse and Rehabilitation · doi:10.2147/sar.s135884 · Cited by 15 · cited 1×
“Other studies have successfully identified high rates of emergency department and other acute care utilization for individuals prior to opioid overdose death (Brady et al., 2015; Maeng et al., 2017).”
BackgroundStein, M. D., Flori, J. N., Risi, M. M., Conti, M. T., Anderson, B. J., & Bailey, G. L. (2017) · Substance Abuse · doi:10.1080/08897077.2017.1353570 · Cited by 14 · cited 1×
“Opportunities also arise when persons who use opioids seek short-term inpatient detoxification, or seek care for complications related to opioid use, such as injection-related infections (Bailey et al., 2013; Davoli et al., 2007; Kim et al., 2016; Ronan and Herzig, 2016; Rosenthal et al., 2016; Stein et al., 2017).”
BackgroundAlexandridis, A. A., Dasgupta, N., McCort, A. D., Ringwalt, C. L., Rosamond, W. D., Chelminski, P. R., & Marshall, S. W. (2019) · Injury Epidemiology · doi:10.1186/s40621-018-0179-2 · Cited by 6
(2018) · BMJ · doi:10.1136/bmj.k4825 · Cited by 6 · cited 1×
“After decades of increases, prescription opioid supply has leveled off and is decreasing; however, increases in opioidrelated deaths have accelerated because of increased use of heroin and illicit fentanyl (Guy et al., 2017; Jeffery et al., 2018; Jones et al., 2014; O’Donnell et al., 2017).”
Background
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Assessment of Annual Cost of Substance Use Disorder in US Hospitals
Peterson, C., Li, M., Xu, L., Mikosz, C. A., & Luo, F. (2021) · JAMA Network Open · doi:10.1001/jamanetworkopen.2021.0242 · Cited by 200
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“, cirrhosis, chronic kidney disease, COPD, asthma, sleep apnea, congestive heart failure; infections related to drug use) (Bosilkovska et al., 2012; Green et al., 2012; Jolley et al., 2015; Larochelle et al., 2019; Vu et al., 2018); and/or 6) injecting drugs (Bazazi et al.”
Influential
Metadata
- 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
- Venue
- Drug and Alcohol Dependence
- Publisher
- Elsevier BV
- Published
- 2019-11
- Volume
- 204
- Pages
- 107537
- ISSN
- 0376-8716 (ISSN-L)
- 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
- 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
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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