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Objective: We assessed overdose mortality by opioid types involved as well as interrelationships between nonmedical use of prescription opioids (NUPO) and heroin and injection drug use (IDU) among adolescents., Method: We examined 2010 and 2016 overdose data by drug type for decedents in the United States ages 15-19 years from the Multiple Cause of Death Files. We also analyzed data from the 2017 National Youth Risk Behavior Survey, a nationally representative survey of high school students. We assessed lifetime NUPO and calculated heroin use and IDU by frequency of lifetime NUPO. Adjusted prevalence ratios (aPRs) were generated, and linear contrast analysis determined dose-response relationships between frequency of lifetime NUPO and the two outcomes., Results: The percentage of deaths involving prescription opioids that also involved illicit opioids such as heroin or fentanyl was 5.5% in 2010 and 25.0% in 2016. We observed a positive dose-response relationship with frequency of lifetime NUPO; aPRs were highest for 20 or more times of NUPO and heroin use (aPR = 49.49, 95% CI [33.39, 73.34]) and IDU (aPR = 44.37, 95% CI [23.16, 84.99]). However, aPRs for heroin and IDU were high even among those reporting just one or two occasions of NUPO (aPRs = 9.25, 95% CI [5.90, 14.49] and 6.63, 95% CI [3.99, 11.02], respectively)., Conclusions: Adolescent prescription opioid overdose deaths now frequently involve illicit opioids. Heroin use and IDU are higher among students reporting even a few instances of NUPO, indicating that students with any NUPO are an important risk group. Clinical, community, and school-based efforts can address NUPO, noting these associations.

Purpose: We investigated the association between county-level trends in opioid prescribing rates, a proxy for opioid misuse, and rates of reported gonorrhea (GC) among males in the United States., Methods: We used linear mixed-model regression analyses to evaluate the association between county-level trends in opioid prescribing rates and rates of reported GC among males during 2010-2015., Results: There was a positive association between trends in county-level opioid prescribing rates and rates of GC among males (β = 0.068, 95% confidence interval [CI] = 0.030, 0.105) during 2010-2015. However, the magnitude of this association decreased significantly over time in counties where opioid prescribing rates decreased (β = -0.018, 95% CI = -0.030, -0.006) and remained stable (β = -0.020, 95% CI = -0.038, -0.002) but was unchanged in counties where opioid prescribing rates increased (β = -0.029, 95% CI = -0.058, 0.001)., Conclusions: During 2010-2015, we found a positive association between increases in county-level opioid prescribing rates, a proxy for opioid misuse, and rates of reported GC among males especially in counties most affected by the opioid crisis. Integrating sexual health with opioid misuse interventions might be beneficial in addressing the GC burden in the United States., (Published by Elsevier Inc.)

Objectives: To estimate heroin overdose trends among insured individuals and characterize patients and healthcare utilization preceding overdose to inform scale-up of effective prevention and treatment., Study Design: Retrospective descriptive analysis., Methods: We analyzed 2010 to 2014 IBM MarketScan Databases and calculated annual heroin overdose rates. For a subset of patients, we describe their comorbidities, where they accessed health services, and select prescription histories prior to their first heroin overdose., Results: Heroin overdose rates were much lower, but increased faster, among the commercially insured compared with Medicaid enrollees from 2010 to 2014 (270.0% vs 94.3%). By 2012, rates among the commercially insured aged 15 to 24 years reached the overall rates in the Medicaid population. All patients had healthcare encounters in the 6 months prior to their first heroin overdose; two-thirds of commercially insured patients had outpatient visits, whereas two-thirds of Medicaid patients had emergency department visits. One month prior to overdose, 24.5% of Medicaid and 8.6% of commercially insured patients had opioid prescriptions. Fewer Medicaid patients had buprenorphine prescriptions (17.8% vs 27.3%) despite similar rates of known substance-related disorders. A higher proportion of Medicaid patients had non-substance-related comorbidities., Conclusions: Heroin overdose rates were persistently higher among the Medicaid population than the commercially insured, with the exception of those aged 15 to 24 years. Our findings on healthcare utilization, comorbidities, and where individuals access services could inform interventions at the point of care prior to a first heroin overdose. Outpatient settings are of particular importance for the growing cohort of young, commercially insured patients with opioid use disorders.

Objective: This study identified sociodemographic, substance use, and multiple opioid prescriber and dispenser risk factors among drug overdose decedents in Rhode Island, in response to an increase in overdose deaths (ODs) involving fentanyl., Methods: This cross-sectional investigation comprised all ODs reviewed by Rhode Island's Office of the State Medical Examiners (OSME) during January 2012 to March 2014. Data for 536 decedents were abstracted from OSME's charts, death certificates, toxicology reports, and Prescription Monitoring Program (PMP) databases. Decedents whose cause of death involved illicit fentanyl (N = 69) were compared with decedents whose causes of death did not involve fentanyl (other drug decedents; N = 467)., Results: Illicit-fentanyl decedents were younger than other drug decedents (P = 0.005). While more other-drug decedents than illicit fentanyl decedents had postmortem toxicological evidence of consuming heroin (31.9% vs 19.8%, P < 0.001) and various pharmaceutical substances (P = 0.002-0.027), third party reports indicated more recent heroin use among illicit fentanyl decedents (62.3% vs 45.6%, P = 0.002). Approximately 35% of decedents filled an opioid prescription within 90 days of death; of these, one-third had a mean daily dosage greater than 100 morphine milligram equivalents (MME/day). Most decedents' opioid prescriptions were filled at one to two dispensers (83.9%) and written by one to two prescribers (75.8%). Notably, 29.2% of illicit fentanyl and 10.5% of other drug decedents filled prescriptions for buprenorphine, which is used to treat opioid use disorders., Conclusions: Illicit-fentanyl deaths frequently involved other illicit drugs (e.g., cocaine, heroin). The proportion of all decedents acquiring greater than 100 MME/day prescription dosages written and/or filled by few prescribers and dispensers is concerning. To protect patients, prescribers and dispensers should review PMP records and substance abuse history prior to providing opioids.

Background: Heroin use and overdose deaths have increased significantly in the United States. Assessing trends in heroin use among demographic and particular substance-using groups can inform prevention efforts., Methods: FDA and CDC analyzed data from the National Survey on Drug Use and Health and National Vital Statistics System reported during 2002-2013. Trends in heroin use among demographic and substance using groups were compared for 2002-2004, 2005-2007, 2008-2010, and 2011-2013. A multivariable logistic regression model was used to identify characteristics associated with heroin abuse or dependence., Results: Annual average rates of past-year heroin use increased from 1.6 per 1,000 persons aged ≥ 12 years in 2002-2004 to 2.6 per 1,000 in 2011-2013. Rates of heroin abuse or dependence were strongly positively correlated with rates of heroin-related overdose deaths over time. For the combined data years 2011-2013, the odds of past-year heroin abuse or dependence were highest among those with past-year cocaine or opioid pain reliever abuse or dependence., Conclusions: Heroin use has increased significantly across most demographic groups. The increase in heroin abuse or dependence parallels the increase in heroin-related overdose deaths. Heroin use is occurring in the context of broader poly-substance use., Implications for Public Health Practice: Further implementation of a comprehensive response that targets the wider range of demographic groups using heroin and addresses the key risk factors for heroin abuse and dependence is needed. Specific response needs include reducing inappropriate prescribing and use of opioids through early identification of persons demonstrating problematic use, stronger prescription drug monitoring programs, and other clinical measures; improving access to, and insurance coverage for, evidence-based substance abuse treatment, including medication-assisted treatment for opioid use disorders; and expanding overdose recognition and response training and access to naloxone to treat opioid pain reliever and heroin overdoses.