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Opioids: A Challenge to Public Health

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A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601).

Deadline for manuscript submissions: closed (30 April 2023) | Viewed by 18190

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Prof. Dr. Icro Maremmani

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Guest Editor

Vincent P. Dole Dual Disorder Unit, Santa Chiara University Hospital, University of Pisa, 56100 Pisa, Italy
Interests: agonist opioid treatment of heroin addicts, especially patients with dual disorders
Special Issues, Collections and Topics in MDPI journals

Prof. Dr. Maurice Dematteis

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Guest Editor

1. Department of Addiction Medicine, Grenoble Alpes University Hospital, Grenoble, France
2. Faculty of Medicine, Grenoble Alpes University, Grenoble, France
Interests: addiction medicine; agonist opioid treatment of heroin addicts; neurological and somatic comorbidity

Special Issue Information

Dear Colleagues,

Overdosing among people exposed to opiates may take one of at least two forms. On one hand, there is accidental overdosing resulting from excessive administration of opiate drugs for various purposes (mainly sedation or painful syndromes), or interactions which increase the expected peak level of opiate agonism or amplify its expected effect at a pharmacodynamic level.

On the other hand, overdosing is one possible consequence of a symptomatic behavior found in opiate addiction—that is, blindness to risk in the self-administration of opiates by addicted individuals, alone or in combination with other substances. Furthermore, other cases may be due to intentional self- poisoning, in other words, suicidal behavior.

A reasonable response to overdose epidemics should certainly be based on overdose prevention, rather than antidote optimization, considering that adequate means of prevention are so easy to implement. As a paradox, antidote optimization may be completely neutralized by a treatment strategy that fails to focus on long-term treatment and thus favors overdose epidemics (in addition to the failure to counteract them), while also inducing an unfavorable change in overdosing typology.

In the thinking of an addictionologist, the issue of overdose prevention is closely connected with the wider issues of addiction treatment and harm reduction and looms as highly dependent on the effectiveness of treatments to put off cravings and reduce impulsive drug-using behavior.

The incidence of overdosing and its lethal nature are indicators of something being wrong, either with the treatment design or with its management, since ongoing standard treatment is known to be largely and promptly effective in preventing overdosing. Overdose epidemics can be interpreted as a finger pointing unmistakably toward the need to improve treatment standards at a very basic level.

Prof. Dr. Icro Maremmani
Prof. Dr. Maurice Dematteis
Guest Editors

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Keywords

opioid use disorder
overdose
resuscitation
prevention
treatment outcome
treatment improvement
public health procedures

Published Papers (7 papers)

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19 pages, 1961 KiB

Open AccessArticle

A Diagram of the Social-Ecological Conditions of Opioid Misuse and Overdose

by Benjamin R. Brady, Ehmer A. Taj, Elena Cameron, Aaron M. Yoder and Jennifer S. De La Rosa

Int. J. Environ. Res. Public Health 2023, 20(20), 6950; https://doi.org/10.3390/ijerph20206950 - 20 Oct 2023

Cited by 1 | Viewed by 2306

Abstract

The United States is experiencing a crisis of opioid misuse and overdose. To understand the underlying factors, researchers have begun looking upstream to identify social and structural determinants. However, no study has yet aggregated these into a comprehensive ecology of opioid overdose. We scoped 68 literature sources and compiled a master list of opioid misuse and overdose conditions. We grouped the conditions and used the Social Ecological Model to organize them into a diagram. We reviewed the diagram with nine subject matter experts (SMEs) who provided feedback on its content, design, and usefulness. From a literature search and SME interviews, we identified 80 unique conditions of opioid overdose and grouped them into 16 categories. In the final diagram, we incorporated 40 SME-recommended changes. In commenting on the diagram’s usefulness, SMEs explained that the diagram could improve intervention planning by demonstrating the complexity of opioid overdose and highlighting structural factors. However, care is required to strike a balance between comprehensiveness and legibility. Multiple design formats may be useful, depending on the communication purpose and audience. This ecological diagram offers a visual perspective of the conditions of opioid overdose. Full article

(This article belongs to the Special Issue Opioids: A Challenge to Public Health)

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11 pages, 863 KiB

Open AccessArticle

State-Level Prevalence and Associates of Opioid Dependence in the USA

by Janni Leung, Gary C. K. Chan, Samuel X. Tan, Caitlin McClure-Thomas, Louisa Degenhardt and Wayne Hall

Int. J. Environ. Res. Public Health 2022, 19(7), 3825; https://doi.org/10.3390/ijerph19073825 - 23 Mar 2022

Cited by 3 | Viewed by 2021

Abstract

Traditionally, opioid-related disease burden was primarily due to heroin use. However, increases in extra-medical (or non-medicinal use of prescription opioids; NMPOs) use has precipitated the current overdose epidemic in North America. We aim to examine the state-level prevalence of heroin and NMPO dependence and their associations with opioid-related mortality and state-level socio-demographic profiles. Data were pooled from the 2005–2014 National Survey on Drug Use and Health (NSDUH). We examine opioid-related mortality from CDC WONDER (Cause of Death database) by the past year prevalence of DSM-IV heroin and NMPO dependence, by age and sex, and their associations with state-level socio-demographic characteristics from census data. State-level rates of heroin dependence were associated with opioid-related death rates in young and mid-aged adults, while rates of NMPO dependence were associated with opioid-related death rates across all ages. The prevalence of heroin dependence was positively associated with state-level GDP/capita and urbanity. State-level NMPO dependence prevalence was associated with higher unemployment, lower GDP/capita, and a lower high-school completion rate. The prevalence of heroin and NMPO dependence are associated with a broad range of geographical and socio-demographic groups. Taking a wider view of populations affected by the opioid epidemic, inclusive interventions for all are needed to reduce opioid-related disease burden. Full article

(This article belongs to the Special Issue Opioids: A Challenge to Public Health)

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10 pages, 557 KiB

Open AccessArticle

Chronic Pain among Individuals Experiencing Homelessness and Its Interdependence with Opioid and Other Substance Use and Mental Illness

by Marc Vogel, Fiona Choi, Jean N. Westenberg, Maurice Cabanis, Nooshin Nikoo, Mohammadali Nikoo, Stephen W. Hwang, Julian Somers, Christian G. Schütz and Michael Krausz

Int. J. Environ. Res. Public Health 2022, 19(1), 5; https://doi.org/10.3390/ijerph19010005 - 21 Dec 2021

Cited by 4 | Viewed by 3496

Abstract

Chronic pain and substance use disorders are serious conditions that are prevalent among homeless populations. The aim of this study was to examine the association between chronic pain and substance use among individuals experiencing homelessness and mental illness. We analyzed cross-sectional data from two sites of the At Home/Chez Soi study (Vancouver and Toronto) using bivariate statistics and multivariate logistic regression. Substance use and chronic pain parameters were assessed with the Maudsley Addiction Profile and purpose-designed short instruments. The sample comprised 828 participants. Mean age was 42.4 years and 54% reported chronic pain. In bivariate analysis, chronic pain was significantly associated with use of opioids and stimulants, daily substance use, polysubstance use and injecting as route of administration. In multivariate analysis, only daily substance use (OR: 1.46, 95% CI: 1.02–2.09) and injecting (OR: 1.81, 95% CI: 1.08–3.05) remained as significant associated factors, whereas neither use of opioids nor use of stimulants specifically were significantly associated with chronic pain. Among participants with chronic pain, daily substance users (50% vs. 22%, p < 0.001) and injectors (66% vs. 24%, p < 0.001) were more likely to use non-prescribed medication for pain. Participants with daily substance use were less likely to receive professional treatment (52% vs. 64%, p = 0.017) and prescribed pain medication (42% vs. 54%, p = 0.023). Our findings suggest an association of chronic pain with patterns related to severity of substance use rather than to specific substance use in homeless persons with mental illness. Interventions aiming at prevention and treatment of chronic pain in this population should consider severity of substance use and associated risk behavior over use of specific substances. Full article

(This article belongs to the Special Issue Opioids: A Challenge to Public Health)

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11 pages, 596 KiB

Open AccessArticle

Switzerland’s Narcotics Regulation Jungle: Off-Label Use, Counterfoil Prescriptions, and Opioid Agonist Therapy in the French-Speaking Cantons

by Caroline Schmitt-Koopmann, Carole-Anne Baud, Valérie Junod and Olivier Simon

Int. J. Environ. Res. Public Health 2021, 18(24), 13164; https://doi.org/10.3390/ijerph182413164 - 14 Dec 2021

Viewed by 2370

Abstract

The word “narcotic” is often first associated with “illicit drugs”. Yet, many “narcotic” and psychotropic substances are, in fact, medicines. Controlled medicines (CM) are products that meet the legal definition of both a “narcotic” under the Swiss Narcotics Act and of a medicine under the Therapeutic Products Act. We aim to examine how similar and how different, respectively, the implementation of CM regulations is throughout French-speaking Switzerland. Based on a legal analysis of the cantonal regulations, we conducted semi-structured interviews with cantonal pharmacists and cantonal physicians. We asked them how they perceive and implement the federal legal requirements. We find that some of these requirements have fallen into disuse, notably the federal duty to notify off-label use of CM. We observe that counterfoil prescriptions in their current paper format are a veritable data graveyard in the sense that they are not actively used to monitor or supervise the market. Moreover, we detect different conditions for opioid agonist treatment authorization. Some cantons require additional physicians’ training or written commitments by the person treated. Our mapping of the CM regulation implementation can serve as a basis for cantons to review their practices. Full article

(This article belongs to the Special Issue Opioids: A Challenge to Public Health)

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12 pages, 2106 KiB

Open AccessArticle

Effect of Eight-Month Exercise Intervention on Bone Outcomes of Young Opioid-Dependent Women

by Zenghui Ding, Zuchang Ma, Xianjun Yang and Yining Sun

Int. J. Environ. Res. Public Health 2021, 18(21), 11336; https://doi.org/10.3390/ijerph182111336 - 28 Oct 2021

Cited by 3 | Viewed by 1901

Abstract

Objective: To evaluate the bone response to an 8 month aerobic gymnastics training program in young opioid-addicted women. Design: Randomized controlled trial (parallel design). Setting: Women’s Specific Drug Rehabilitation Center in China. Patients: One hundred and two young women with low bone quality and previous opioid addiction were divided into two groups: (a) the low bone quality intervention experimental group (n = 55; age: 30.3 ± 6.1) and (b) the low bone quality observed control group (observation group; n = 47; age: 29.0 ± 5.3). Interventions: The intervention group took aerobic gymnastics regularly for 80 min/d and 5 d/wk for 8 months and completed follow-up testing. Main Outcome Measures: Substance use history and other life habits affecting bone quality were assessed by questionnaire-based interviews. Bone quality (stiffness-index, T-score, Z-score) was examined with quantitative ultrasound. Anthropometric characteristics (body weight, fat-free mass, fat mass) were obtained by bioelectrical impedance analysis. Results: After the 8 month intervention, the stiffness index of bone quality increased significantly (before: 82 ± 6, after: 108 ± 14, p < 0.05) in the experimental group. However, the bone quality did not change significantly in the controls (before: 79 ± 10, after: 77 ± 13, p > 0.05). The bone change in the difference group was significant (experimental group: 31.7% vs observation group: -0.03%). Fat mass decreased in the experimental group (experimental group: before: 19.6 ± 3.7 kg, after: 18.8 ± 4.0 kg, p < 0.05). Meanwhile, the change in fat-free mass was the determination of the change in bone quality in the experimental group. Conclusions: Our results suggested that aerobic gymnastics intervention can be an effective strategy for the prevention and treatment of drug-induced osteoporosis in detoxification addicts. Full article

(This article belongs to the Special Issue Opioids: A Challenge to Public Health)

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13 pages, 1523 KiB

Open AccessArticle

Adult-Attention Deficit Hyperactive Disorder Symptoms Seem Not to Influence the Outcome of an Enhanced Agonist Opioid Treatment: A 30-Year Follow-Up

by Angelo G. I. Maremmani, Pasqualina Rocco, Filippo Della Rocca, Giulio Perugi, Mario Miccoli and Icro Maremmani

Int. J. Environ. Res. Public Health 2021, 18(20), 10997; https://doi.org/10.3390/ijerph182010997 - 19 Oct 2021

Cited by 3 | Viewed by 3197

Abstract

The role of opioids and opioid medications in ADHD symptoms is still largely understudied. We tested the hypothesis that, in Heroin Use Disorder (HUD), when patients are treated with Agonist Opioid medications (AOT), treatment outcome is associated with the presence of Adult Attention-Deficit/Hyperactive Disorder (A-ADHD) symptomatology. A retrospective cohort study of 130 HUD patients in Castelfranco Veneto, Italy, covering 30 years, was divided into two groups according to the Adult ADHD Self-Report Scale (ASRS) score and compared them using demographic, clinical and pharmacological factors. Survival in treatment was studied by utilizing the available data for leaving treatment and relapsing into addictive behavior and for mortality during treatment as poor primary outcomes. Thirty-five HUD subjects (26.9%) were unlikely to have A-ADHD symptomatology, and 95 (73.1%) were likely to have it. Only current age and co-substance use at treatment entry differed significantly between groups. Censored patients were 29 (82.9%) for HUD patients and 70 (73.9%) for A-ADHD/HUD patients (Mantel-Cox test = 0.66 p = 0.415). There were no significant linear trends indicative of a poorer outcome with the presence of A-ADHD after adjustment for demographic, clinical and pharmacological factors. Conclusions: ADHD symptomatology does not seem to exert any influence on the retention in AOT of HUD patients. Full article

(This article belongs to the Special Issue Opioids: A Challenge to Public Health)

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8 pages, 323 KiB

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Agonist Treatment for Opioid Dependence Syndrome: The Impact of Current Understanding upon Recommendations for Policy Initiatives

by Cheryl Dickson, Valérie Junod, René Stamm, Emilien Jeannot, Robert Hämmig, Willem Scholten and Olivier Simon

Int. J. Environ. Res. Public Health 2021, 18(19), 10155; https://doi.org/10.3390/ijerph181910155 - 27 Sep 2021

Cited by 1 | Viewed by 1618

Abstract

The provision of opioid agonist treatments (OATs), as a standard approach towards opioid dependence syndrome, differs widely between countries. In response to access disparities, in 2014, the Council of Europe’s Pompidou Group first brought together an expert group on framework conditions for the treatment of opioid dependence. The group used a Delphi approach to structure their discussions and develop guiding principles for the modernisation of OAT regulations and legislation. The expert group identified some 60 guiding principles, which were then the subject of wide public consultation. Endorsed by Pompidou Group member states, the final report identified four key recommendations: (1) Prescription and delivery without prior authorisation schemes; (2) Effective removal of financial barriers to access to care; (3) Coordination and follow-up by a national consultative body; and (4) Neutral, precise and respectful terminology. During meetings, the expert group hypothesised that inequalities in OAT access are likely to be linked to underlying rationales which in theory are contradictory, but in practice co-exist within the different political frameworks. The present article considers the perceived influence upon different regulatory frameworks. Discussion is centred around the potential impact of underlying rationales upon the effective implementation of a modernised framework. Full article

(This article belongs to the Special Issue Opioids: A Challenge to Public Health)

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