Mohammad S Jalali, Catherine DiGennaro, Abby Guitar, Karen Lew, Hazhir Rahmandad
Simulation models are increasingly being used to inform epidemiologic studies and health policy, yet there is great variation in their transparency and reproducibility. In this review, we provide an overview of applications of simulation models in health policy and epidemiology, analyze the use of best reporting practices, and assess the reproducibility of the models using predefined, categorical criteria. We identified and analyzed 1,613 applicable articles and found exponential growth in the number of studies over the past half century, with the highest growth in dynamic modeling approaches. The largest subset of studies focused on disease policy models (70%), within which pathological conditions, viral diseases, neoplasms, and cardiovascular diseases account for one-third of the articles. Model details were not reported in almost half of the studies. We also provide in-depth analysis of modeling best practices, reporting quality and reproducibility of models for a subset of 100 articles (50 highly cited and 50 randomly selected from the remaining articles). Only 7 of 26 in-depth evaluation criteria were satisfied by more than 80% of samples. We identify areas for increased application of simulation modeling and opportunities to enhance the rigor and documentation in the conduct and reporting of simulation modeling in epidemiology and health policy.
{"title":"Evolution and Reproducibility of Simulation Modeling in Epidemiology and Health Policy Over Half a Century.","authors":"Mohammad S Jalali, Catherine DiGennaro, Abby Guitar, Karen Lew, Hazhir Rahmandad","doi":"10.1093/epirev/mxab006","DOIUrl":"https://doi.org/10.1093/epirev/mxab006","url":null,"abstract":"<p><p>Simulation models are increasingly being used to inform epidemiologic studies and health policy, yet there is great variation in their transparency and reproducibility. In this review, we provide an overview of applications of simulation models in health policy and epidemiology, analyze the use of best reporting practices, and assess the reproducibility of the models using predefined, categorical criteria. We identified and analyzed 1,613 applicable articles and found exponential growth in the number of studies over the past half century, with the highest growth in dynamic modeling approaches. The largest subset of studies focused on disease policy models (70%), within which pathological conditions, viral diseases, neoplasms, and cardiovascular diseases account for one-third of the articles. Model details were not reported in almost half of the studies. We also provide in-depth analysis of modeling best practices, reporting quality and reproducibility of models for a subset of 100 articles (50 highly cited and 50 randomly selected from the remaining articles). Only 7 of 26 in-depth evaluation criteria were satisfied by more than 80% of samples. We identify areas for increased application of simulation modeling and opportunities to enhance the rigor and documentation in the conduct and reporting of simulation modeling in epidemiology and health policy.</p>","PeriodicalId":50510,"journal":{"name":"Epidemiologic Reviews","volume":"43 1","pages":"166-175"},"PeriodicalIF":5.5,"publicationDate":"2022-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/07/ed/mxab006.PMC8763126.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10770253","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Mollie E Wood, Angela Lupattelli, Kristin Palmsten, Gretchen Bandoli, Caroline Hurault-Delarue, Christine Damase-Michel, Christina D Chambers, Hedvig M E Nordeng, Marleen M H J van Gelder
In many perinatal pharmacoepidemiologic studies, exposure to a medication is classified as "ever exposed" versus "never exposed" within each trimester or even over the entire pregnancy. This approach is often far from real-world exposure patterns, may lead to exposure misclassification, and does not to incorporate important aspects such as dosage, timing of exposure, and treatment duration. Alternative exposure modeling methods can better summarize complex, individual-level medication use trajectories or time-varying exposures from information on medication dosage, gestational timing of use, and frequency of use. We provide an overview of commonly used methods for more refined definitions of real-world exposure to medication use during pregnancy, focusing on the major strengths and limitations of the techniques, including the potential for method-specific biases. Unsupervised clustering methods, including k-means clustering, group-based trajectory models, and hierarchical cluster analysis, are of interest because they enable visual examination of medication use trajectories over time in pregnancy and complex individual-level exposures, as well as providing insight into comedication and drug-switching patterns. Analytical techniques for time-varying exposure methods, such as extended Cox models and Robins' generalized methods, are useful tools when medication exposure is not static during pregnancy. We propose that where appropriate, combining unsupervised clustering techniques with causal modeling approaches may be a powerful approach to understanding medication safety in pregnancy, and this framework can also be applied in other areas of epidemiology.
{"title":"Longitudinal Methods for Modeling Exposures in Pharmacoepidemiologic Studies in Pregnancy.","authors":"Mollie E Wood, Angela Lupattelli, Kristin Palmsten, Gretchen Bandoli, Caroline Hurault-Delarue, Christine Damase-Michel, Christina D Chambers, Hedvig M E Nordeng, Marleen M H J van Gelder","doi":"10.1093/epirev/mxab002","DOIUrl":"https://doi.org/10.1093/epirev/mxab002","url":null,"abstract":"<p><p>In many perinatal pharmacoepidemiologic studies, exposure to a medication is classified as \"ever exposed\" versus \"never exposed\" within each trimester or even over the entire pregnancy. This approach is often far from real-world exposure patterns, may lead to exposure misclassification, and does not to incorporate important aspects such as dosage, timing of exposure, and treatment duration. Alternative exposure modeling methods can better summarize complex, individual-level medication use trajectories or time-varying exposures from information on medication dosage, gestational timing of use, and frequency of use. We provide an overview of commonly used methods for more refined definitions of real-world exposure to medication use during pregnancy, focusing on the major strengths and limitations of the techniques, including the potential for method-specific biases. Unsupervised clustering methods, including k-means clustering, group-based trajectory models, and hierarchical cluster analysis, are of interest because they enable visual examination of medication use trajectories over time in pregnancy and complex individual-level exposures, as well as providing insight into comedication and drug-switching patterns. Analytical techniques for time-varying exposure methods, such as extended Cox models and Robins' generalized methods, are useful tools when medication exposure is not static during pregnancy. We propose that where appropriate, combining unsupervised clustering techniques with causal modeling approaches may be a powerful approach to understanding medication safety in pregnancy, and this framework can also be applied in other areas of epidemiology.</p>","PeriodicalId":50510,"journal":{"name":"Epidemiologic Reviews","volume":"43 1","pages":"130-146"},"PeriodicalIF":5.5,"publicationDate":"2022-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/47/62/mxab002.PMC8763114.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9487891","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The increased focus on the public health burden of antimicrobial resistance (AMR) raises conceptual challenges, such as determining how much harm multidrug-resistant organisms do compared to what, or how to establish the burden. Here, we present a counterfactual framework and provide guidance to harmonize methodologies and optimize study quality. In AMR-burden studies, 2 counterfactual approaches have been applied: the harm of drug-resistant infections relative to the harm of the same drug-susceptible infections (the susceptible-infection counterfactual); and the total harm of drug-resistant infections relative to a situation where such infections were prevented (the no-infection counterfactual). We propose to use an intervention-based causal approach to determine the most appropriate counterfactual. We show that intervention scenarios, species of interest, and types of infections influence the choice of counterfactual. We recommend using purpose-designed cohort studies to apply this counterfactual framework, whereby the selection of cohorts (patients with drug-resistant, drug-susceptible infections, and those with no infection) should be based on matching on time to infection through exposure density sampling to avoid biased estimates. Application of survival methods is preferred, considering competing events. We conclude by advocating estimation of the burden of AMR by using the no-infection and susceptible-infection counterfactuals. The resulting numbers will provide policy-relevant information about the upper and lower bound of future interventions designed to control AMR. The counterfactuals should be applied in cohort studies, whereby selection of the unexposed cohorts should be based on exposure density sampling, applying methods avoiding time-dependent bias and confounding.
{"title":"Burden of Antimicrobial Resistance: Compared to What?","authors":"Marlieke E A de Kraker, Marc Lipsitch","doi":"10.1093/epirev/mxab001","DOIUrl":"https://doi.org/10.1093/epirev/mxab001","url":null,"abstract":"<p><p>The increased focus on the public health burden of antimicrobial resistance (AMR) raises conceptual challenges, such as determining how much harm multidrug-resistant organisms do compared to what, or how to establish the burden. Here, we present a counterfactual framework and provide guidance to harmonize methodologies and optimize study quality. In AMR-burden studies, 2 counterfactual approaches have been applied: the harm of drug-resistant infections relative to the harm of the same drug-susceptible infections (the susceptible-infection counterfactual); and the total harm of drug-resistant infections relative to a situation where such infections were prevented (the no-infection counterfactual). We propose to use an intervention-based causal approach to determine the most appropriate counterfactual. We show that intervention scenarios, species of interest, and types of infections influence the choice of counterfactual. We recommend using purpose-designed cohort studies to apply this counterfactual framework, whereby the selection of cohorts (patients with drug-resistant, drug-susceptible infections, and those with no infection) should be based on matching on time to infection through exposure density sampling to avoid biased estimates. Application of survival methods is preferred, considering competing events. We conclude by advocating estimation of the burden of AMR by using the no-infection and susceptible-infection counterfactuals. The resulting numbers will provide policy-relevant information about the upper and lower bound of future interventions designed to control AMR. The counterfactuals should be applied in cohort studies, whereby selection of the unexposed cohorts should be based on exposure density sampling, applying methods avoiding time-dependent bias and confounding.</p>","PeriodicalId":50510,"journal":{"name":"Epidemiologic Reviews","volume":"43 1","pages":"53-64"},"PeriodicalIF":5.5,"publicationDate":"2022-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1093/epirev/mxab001","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10425629","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Babak Moazen, Kate Dolan, Sahar Saeedi Moghaddam, Masoud Lotfizadeh, Karen Duke, Florian Neuhann, Heino Stöver, Albrecht Jahn
Needle and syringe programs (NSPs) are among the most effective interventions for controlling the transmission of infection among people who inject drugs in prisons. We evaluated the availability, accessibility, and coverage of NSPs in prisons in European Union (EU) countries. In line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria, we systematically searched 4 databases of peer-reviewed publications (MEDLINE (PubMed), ISI Web of Science, EBSCO, and ScienceDirect) and 53 databases containing gray literature to collect data published from January 2008 to August 2018. A total of 23,969 documents (17,297 papers and 6,672 gray documents) were identified, of which 26 were included in the study. In 2018, imprisonment rates in 28 EU countries ranged between 51 per 100,000 population in Finland and 235 per 100,000 population in Lithuania. Only 4 countries were found to have NSPs in prisons: Germany (in 1 prison), Luxembourg (no coverage data were found), Romania (available in more than 50% of prisons), and Spain (in all prisons). Portugal stopped an NSP after a 6-month pilot phase. Despite the protective impact of prison-based NSPs on infection transmission, only 4 EU countries distribute sterile syringes among people who inject drugs in prisons, and coverage of the programs within these countries is very low. Since most prisoners will eventually return to the community, lack of NSPs in EU prisons not only is a threat to the health of prisoners but also endangers public health.
针头和注射器规划是控制监狱内注射吸毒者感染传播的最有效干预措施之一。我们评估了欧盟国家监狱中nsp的可得性、可及性和覆盖范围。根据系统评价和荟萃分析的首选报告项目(PRISMA)标准,我们系统地检索了4个同行评议出版物数据库(MEDLINE (PubMed), ISI Web of Science, EBSCO和ScienceDirect)和53个包含灰色文献的数据库,以收集2008年1月至2018年8月发表的数据。共发现文献23,969份(论文17,297份,灰色文献6,672份),其中26份纳入本研究。2018年,28个欧盟国家的监禁率在芬兰的每10万人中有51人,立陶宛的每10万人中有235人。只有4个国家的监狱中有国家安全服务提供者:德国(在1所监狱中)、卢森堡(没有发现覆盖数据)、罗马尼亚(在50%以上的监狱中)和西班牙(在所有监狱中)。葡萄牙在6个月的试点阶段后停止了NSP。尽管以监狱为基础的国家卫生服务方案对感染传播具有保护作用,但只有4个欧盟国家向在监狱注射毒品的人分发无菌注射器,而且这些国家内项目的覆盖率非常低。由于大多数囚犯最终将返回社区,欧盟监狱中缺乏国家卫生服务提供者不仅对囚犯的健康构成威胁,而且危害公共卫生。
{"title":"Availability, Accessibility, and Coverage of Needle and Syringe Programs in Prisons in the European Union.","authors":"Babak Moazen, Kate Dolan, Sahar Saeedi Moghaddam, Masoud Lotfizadeh, Karen Duke, Florian Neuhann, Heino Stöver, Albrecht Jahn","doi":"10.1093/epirev/mxaa003","DOIUrl":"https://doi.org/10.1093/epirev/mxaa003","url":null,"abstract":"<p><p>Needle and syringe programs (NSPs) are among the most effective interventions for controlling the transmission of infection among people who inject drugs in prisons. We evaluated the availability, accessibility, and coverage of NSPs in prisons in European Union (EU) countries. In line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria, we systematically searched 4 databases of peer-reviewed publications (MEDLINE (PubMed), ISI Web of Science, EBSCO, and ScienceDirect) and 53 databases containing gray literature to collect data published from January 2008 to August 2018. A total of 23,969 documents (17,297 papers and 6,672 gray documents) were identified, of which 26 were included in the study. In 2018, imprisonment rates in 28 EU countries ranged between 51 per 100,000 population in Finland and 235 per 100,000 population in Lithuania. Only 4 countries were found to have NSPs in prisons: Germany (in 1 prison), Luxembourg (no coverage data were found), Romania (available in more than 50% of prisons), and Spain (in all prisons). Portugal stopped an NSP after a 6-month pilot phase. Despite the protective impact of prison-based NSPs on infection transmission, only 4 EU countries distribute sterile syringes among people who inject drugs in prisons, and coverage of the programs within these countries is very low. Since most prisoners will eventually return to the community, lack of NSPs in EU prisons not only is a threat to the health of prisoners but also endangers public health.</p>","PeriodicalId":50510,"journal":{"name":"Epidemiologic Reviews","volume":"42 1","pages":"19-26"},"PeriodicalIF":5.5,"publicationDate":"2020-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1093/epirev/mxaa003","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38463951","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Mirinda Ann Gormley, Courtney T Blondino, DaShaunda D H Taylor, Elizabeth Lowery, James S Clifford, Benjamin Burkart, Whitney C Graves, Elizabeth C Prom-Wormley, Juan Lu
The effectiveness of opiate treatment programs (OTPs) can be significantly influenced by co-occurring substance use, yet there are no standardized guidelines for assessing the influence of co-occurring substance use on treatment outcomes. In this review, we aim to provide an overview on the status of the assessment of co-occurring substance use during participation in OTPs in the United States. We searched 4 databases-MEDLINE/PubMed, EMBASE, PsychINFO, and the Cumulative Index to Nursing and Allied Health Literature (CINAHL)-from database inception to November 2018 to select relevant publications on OTPs that assessed participants' co-occurring substance use. We used a standardized protocol to extract study, intervention, and co-occurring substance use characteristics. Methodological quality was assessed using the Quality in Prognosis Studies tool. Of the 3,219 titles screened, 614 abstracts and 191 full-text original publications were assessed, leaving 85 eligible articles. Co-occurring substance use was most often assessed during opioid treatments using combined (pharmacological and behavioral) (n = 57 studies) and pharmacological (n = 25 studies) interventions. Cocaine, alcohol, marijuana, and benzodiazepines were frequently measured, while amphetamines and tobacco were rarely assessed. Great variation existed between studies in the timing and measurement of co-occurring substance use, as well as definitions for substances and polysubstance/polydrug use. Inconsistencies in the investigation of co-occurring substance use make comparison of results across studies challenging. Standardized measures and consensus on research on co-occurring substance use is needed to produce the evidence required to develop personalized treatment programs for persons using multiple substances and to inform best-practice guidelines for addressing polydrug use during participation in OTPs.
{"title":"Assessment of Co-Occurring Substance Use During Opiate Treatment Programs in the United States.","authors":"Mirinda Ann Gormley, Courtney T Blondino, DaShaunda D H Taylor, Elizabeth Lowery, James S Clifford, Benjamin Burkart, Whitney C Graves, Elizabeth C Prom-Wormley, Juan Lu","doi":"10.1093/epirev/mxaa009","DOIUrl":"https://doi.org/10.1093/epirev/mxaa009","url":null,"abstract":"<p><p>The effectiveness of opiate treatment programs (OTPs) can be significantly influenced by co-occurring substance use, yet there are no standardized guidelines for assessing the influence of co-occurring substance use on treatment outcomes. In this review, we aim to provide an overview on the status of the assessment of co-occurring substance use during participation in OTPs in the United States. We searched 4 databases-MEDLINE/PubMed, EMBASE, PsychINFO, and the Cumulative Index to Nursing and Allied Health Literature (CINAHL)-from database inception to November 2018 to select relevant publications on OTPs that assessed participants' co-occurring substance use. We used a standardized protocol to extract study, intervention, and co-occurring substance use characteristics. Methodological quality was assessed using the Quality in Prognosis Studies tool. Of the 3,219 titles screened, 614 abstracts and 191 full-text original publications were assessed, leaving 85 eligible articles. Co-occurring substance use was most often assessed during opioid treatments using combined (pharmacological and behavioral) (n = 57 studies) and pharmacological (n = 25 studies) interventions. Cocaine, alcohol, marijuana, and benzodiazepines were frequently measured, while amphetamines and tobacco were rarely assessed. Great variation existed between studies in the timing and measurement of co-occurring substance use, as well as definitions for substances and polysubstance/polydrug use. Inconsistencies in the investigation of co-occurring substance use make comparison of results across studies challenging. Standardized measures and consensus on research on co-occurring substance use is needed to produce the evidence required to develop personalized treatment programs for persons using multiple substances and to inform best-practice guidelines for addressing polydrug use during participation in OTPs.</p>","PeriodicalId":50510,"journal":{"name":"Epidemiologic Reviews","volume":"42 1","pages":"79-102"},"PeriodicalIF":5.5,"publicationDate":"2020-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1093/epirev/mxaa009","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38499545","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pieter Baker, Leo Beletsky, Liliana Avalos, Christopher Venegas, Carlos Rivera, Steffanie A Strathdee, Javier Cepeda
Drug-law enforcement constitutes a structural determinant of health among people who inject drugs (PWID). Street encounters between police and PWID (e.g., syringe confiscation, physical assault) have been associated with health harms, but these relationships have not been systematically assessed. We conducted a systematic literature review to evaluate the contribution of policing to risk of human immunodeficiency virus (HIV) infection among PWID. We screened MEDLINE, sociological databases, and gray literature for studies published from 1981 to November 2018 that included estimates of HIV infection/risk behaviors and street policing encounters. We extracted and summarized quantitative findings from all eligible studies. We screened 8,201 abstracts, reviewed 175 full-text articles, and included 27 eligible analyses from 9 countries (Canada, China, India, Malaysia, Mexico, Russia, Thailand, Ukraine, and the United States). Heterogeneity in variable and endpoint selection precluded meta-analyses. In 5 (19%) studies, HIV infection among PWID was significantly associated with syringe confiscation, reluctance to buy/carry syringes for fear of police, rushed injection due to a police presence, fear of arrest, being arrested for planted drugs, and physical abuse. Twenty-one (78%) studies identified policing practices to be associated with HIV risk behaviors related to injection drug use (e.g., syringe-sharing, using a "shooting gallery"). In 9 (33%) studies, policing was associated with PWID avoidance of harm reduction services, including syringe exchange, methadone maintenance, and safe consumption facilities. Evidence suggests that policing shapes HIV risk among PWID, but lower-income settings are underrepresented. Curbing injection-related HIV risk necessitates additional structural interventions. Methodological harmonization could facilitate knowledge generation on the role of police as a determinant of population health.
{"title":"Policing Practices and Risk of HIV Infection Among People Who Inject Drugs.","authors":"Pieter Baker, Leo Beletsky, Liliana Avalos, Christopher Venegas, Carlos Rivera, Steffanie A Strathdee, Javier Cepeda","doi":"10.1093/epirev/mxaa010","DOIUrl":"10.1093/epirev/mxaa010","url":null,"abstract":"<p><p>Drug-law enforcement constitutes a structural determinant of health among people who inject drugs (PWID). Street encounters between police and PWID (e.g., syringe confiscation, physical assault) have been associated with health harms, but these relationships have not been systematically assessed. We conducted a systematic literature review to evaluate the contribution of policing to risk of human immunodeficiency virus (HIV) infection among PWID. We screened MEDLINE, sociological databases, and gray literature for studies published from 1981 to November 2018 that included estimates of HIV infection/risk behaviors and street policing encounters. We extracted and summarized quantitative findings from all eligible studies. We screened 8,201 abstracts, reviewed 175 full-text articles, and included 27 eligible analyses from 9 countries (Canada, China, India, Malaysia, Mexico, Russia, Thailand, Ukraine, and the United States). Heterogeneity in variable and endpoint selection precluded meta-analyses. In 5 (19%) studies, HIV infection among PWID was significantly associated with syringe confiscation, reluctance to buy/carry syringes for fear of police, rushed injection due to a police presence, fear of arrest, being arrested for planted drugs, and physical abuse. Twenty-one (78%) studies identified policing practices to be associated with HIV risk behaviors related to injection drug use (e.g., syringe-sharing, using a \"shooting gallery\"). In 9 (33%) studies, policing was associated with PWID avoidance of harm reduction services, including syringe exchange, methadone maintenance, and safe consumption facilities. Evidence suggests that policing shapes HIV risk among PWID, but lower-income settings are underrepresented. Curbing injection-related HIV risk necessitates additional structural interventions. Methodological harmonization could facilitate knowledge generation on the role of police as a determinant of population health.</p>","PeriodicalId":50510,"journal":{"name":"Epidemiologic Reviews","volume":"42 1","pages":"27-40"},"PeriodicalIF":5.5,"publicationDate":"2020-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7879596/pdf/mxaa010.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38692899","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The National Institutes of Health is investing hundreds of millions of dollars into new research on opioids. As these studies yield insights and results, their results will have to change policy and practice before they can bend the curve of the epidemic. However, the United States does not have a strong track record of translating evidence on drug policy into action. Three reasons for the translation gap are the historical legacy of drugs in the United States, vested interests, and politics. Researchers can become engaged in policy and political processes to strengthen the US response.
{"title":"The Role of Evidence in the US Response to the Opioid Crisis.","authors":"Joshua M Sharfstein, Yngvild Olsen","doi":"10.1093/epirev/mxaa004","DOIUrl":"https://doi.org/10.1093/epirev/mxaa004","url":null,"abstract":"<p><p>The National Institutes of Health is investing hundreds of millions of dollars into new research on opioids. As these studies yield insights and results, their results will have to change policy and practice before they can bend the curve of the epidemic. However, the United States does not have a strong track record of translating evidence on drug policy into action. Three reasons for the translation gap are the historical legacy of drugs in the United States, vested interests, and politics. Researchers can become engaged in policy and political processes to strengthen the US response.</p>","PeriodicalId":50510,"journal":{"name":"Epidemiologic Reviews","volume":"42 1","pages":"167-170"},"PeriodicalIF":5.5,"publicationDate":"2020-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1093/epirev/mxaa004","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38518971","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Courtney T Blondino, Mirinda Ann Gormley, DaShaunda D H Taylor, Elizabeth Lowery, James S Clifford, Benjamin Burkart, Whitney C Graves, Juan Lu, Elizabeth C Prom-Wormley
This systematic review describes the influence of co-occurring substance use on the effectiveness of opiate treatment programs. MEDLINE/PubMed, Embase, PsychINFO, and the Cumulative Index to Nursing and Allied Health Literature were searched from database inception to November 28, 2018, to identify eligible opioid treatment studies in the United States that assessed the relationship between co-occurring substance use and treatment outcome (i.e., opioid abstinence and treatment retention). A total of 34 eligible studies were included. Overall, co-occurring substance use was associated with negative treatment outcomes regardless of intervention type. However, patterns varied by substance and intervention type. In particular, co-occurring use of cocaine or marijuana with opioids was associated with reduced treatment retention and opioid abstinence regardless of intervention type. Co-occurring use of amphetamines, compared with no use or reduced use of amphetamines, decreased treatment retention. Co-occurring use of alcohol was both positively and negatively associated with treatment outcomes. One study reported a significant positive association between sedative use and opioid abstinence. Generally, findings suggest that combined interventions reported better health outcomes compared with pharmacological or behavioral intervention studies alone. The findings of this review emphasize the need to comprehensively study and address co-occurring substance use to improve opiate treatment programs.
{"title":"The Influence of Co-Occurring Substance Use on the Effectiveness of Opiate Treatment Programs According to Intervention Type.","authors":"Courtney T Blondino, Mirinda Ann Gormley, DaShaunda D H Taylor, Elizabeth Lowery, James S Clifford, Benjamin Burkart, Whitney C Graves, Juan Lu, Elizabeth C Prom-Wormley","doi":"10.1093/epirev/mxaa005","DOIUrl":"https://doi.org/10.1093/epirev/mxaa005","url":null,"abstract":"<p><p>This systematic review describes the influence of co-occurring substance use on the effectiveness of opiate treatment programs. MEDLINE/PubMed, Embase, PsychINFO, and the Cumulative Index to Nursing and Allied Health Literature were searched from database inception to November 28, 2018, to identify eligible opioid treatment studies in the United States that assessed the relationship between co-occurring substance use and treatment outcome (i.e., opioid abstinence and treatment retention). A total of 34 eligible studies were included. Overall, co-occurring substance use was associated with negative treatment outcomes regardless of intervention type. However, patterns varied by substance and intervention type. In particular, co-occurring use of cocaine or marijuana with opioids was associated with reduced treatment retention and opioid abstinence regardless of intervention type. Co-occurring use of amphetamines, compared with no use or reduced use of amphetamines, decreased treatment retention. Co-occurring use of alcohol was both positively and negatively associated with treatment outcomes. One study reported a significant positive association between sedative use and opioid abstinence. Generally, findings suggest that combined interventions reported better health outcomes compared with pharmacological or behavioral intervention studies alone. The findings of this review emphasize the need to comprehensively study and address co-occurring substance use to improve opiate treatment programs.</p>","PeriodicalId":50510,"journal":{"name":"Epidemiologic Reviews","volume":"42 1","pages":"57-78"},"PeriodicalIF":5.5,"publicationDate":"2020-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1093/epirev/mxaa005","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38394890","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Christopher M Jones, Faraah Bekheet, Ju Nyeong Park, G Caleb Alexander
The opioid overdose epidemic is typically described as having occurred in 3 waves, with morbidity and mortality accruing over time principally from prescription opioids (1999-2010), heroin (2011-2013), and illicit fentanyl and other synthetic opioids (2014-present). However, the increasing presence of synthetic opioids mixed into the illicit drug supply, including with stimulants such as cocaine and methamphetamine, as well as rising stimulant-related deaths, reflects the rapidly evolving nature of the overdose epidemic, posing urgent and novel public health challenges. We synthesize the evidence underlying these trends, consider key questions such as where and how concomitant exposure to fentanyl and stimulants is occurring, and identify actions for key stakeholders regarding how these emerging threats, and continued evolution of the overdose epidemic, can best be addressed.
{"title":"The Evolving Overdose Epidemic: Synthetic Opioids and Rising Stimulant-Related Harms.","authors":"Christopher M Jones, Faraah Bekheet, Ju Nyeong Park, G Caleb Alexander","doi":"10.1093/epirev/mxaa011","DOIUrl":"https://doi.org/10.1093/epirev/mxaa011","url":null,"abstract":"<p><p>The opioid overdose epidemic is typically described as having occurred in 3 waves, with morbidity and mortality accruing over time principally from prescription opioids (1999-2010), heroin (2011-2013), and illicit fentanyl and other synthetic opioids (2014-present). However, the increasing presence of synthetic opioids mixed into the illicit drug supply, including with stimulants such as cocaine and methamphetamine, as well as rising stimulant-related deaths, reflects the rapidly evolving nature of the overdose epidemic, posing urgent and novel public health challenges. We synthesize the evidence underlying these trends, consider key questions such as where and how concomitant exposure to fentanyl and stimulants is occurring, and identify actions for key stakeholders regarding how these emerging threats, and continued evolution of the overdose epidemic, can best be addressed.</p>","PeriodicalId":50510,"journal":{"name":"Epidemiologic Reviews","volume":"42 1","pages":"154-166"},"PeriodicalIF":5.5,"publicationDate":"2020-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1093/epirev/mxaa011","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38873254","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Victor Puac-Polanco, Stanford Chihuri, David S Fink, Magdalena Cerdá, Katherine M Keyes, Guohua Li
Prescription drug monitoring programs (PDMPs) are a crucial component of federal and state governments' response to the opioid epidemic. Evidence about the effectiveness of PDMPs in reducing prescription opioid-related adverse outcomes is mixed. We conducted a systematic review to examine whether PDMP implementation within the United States is associated with changes in 4 prescription opioid-related outcome domains: opioid prescribing behaviors, opioid diversion and supply, opioid-related morbidity and substance-use disorders, and opioid-related deaths. We searched for eligible publications in Embase, Google Scholar, MEDLINE, and Web of Science. A total of 29 studies, published between 2009 and 2019, met the inclusion criteria. Of the 16 studies examining PDMPs and prescribing behaviors, 11 found that implementing PDMPs reduced prescribing behaviors. All 3 studies on opioid diversion and supply reported reductions in the examined outcomes. In the opioid-related morbidity and substance-use disorders domain, 7 of 8 studies found associations with prescription opioid-related outcomes. Four of 8 studies in the opioid-related deaths domain reported reduced mortality rates. Despite the mixed findings, emerging evidence supports that the implementation of state PDMPs reduces opioid prescriptions, opioid diversion and supply, and opioid-related morbidity and substance-use disorder outcomes. When PDMP characteristics were examined, mandatory access provisions were associated with reductions in prescribing behaviors, diversion outcomes, hospital admissions, substance-use disorders, and mortality rates. Inconsistencies in the evidence base across outcome domains are due to analytical approaches across studies and, to some extent, heterogeneities in PDMP policies implemented across states and over time.
处方药监测项目(PDMPs)是联邦和州政府应对阿片类药物流行的重要组成部分。关于PDMPs在减少处方阿片类药物相关不良后果方面的有效性的证据参差不齐。我们进行了一项系统综述,以检查PDMP在美国的实施是否与4个处方阿片类药物相关结果领域的变化有关:阿片类药物处方行为、阿片类药物转移和供应、阿片类药物相关发病率和物质使用障碍以及阿片类药物相关死亡。我们在Embase、Google Scholar、MEDLINE和Web of Science中搜索了符合条件的出版物。2009年至2019年间发表的29项研究符合纳入标准。在16项检查PDMPs和处方行为的研究中,11项发现实施PDMPs减少了处方行为。关于阿片类药物转移和供应的所有3项研究都报告了所检查结果的减少。在阿片类药物相关发病率和物质使用障碍领域,8项研究中有7项发现了与处方阿片类药物相关结果的关联。在阿片类药物相关死亡领域的8项研究中,有4项报告死亡率降低。尽管结果喜忧参半,但新出现的证据支持,国家PDMPs的实施减少了阿片类药物处方、阿片类药物的转移和供应,以及阿片类药物相关的发病率和物质使用障碍的结果。当检查PDMP特征时,强制性获取规定与处方行为、转移结果、住院率、物质使用障碍和死亡率的减少有关。结果领域之间证据基础的不一致是由于不同研究的分析方法,以及在某种程度上,不同州和不同时期实施的PDMP政策的异质性。
{"title":"Prescription Drug Monitoring Programs and Prescription Opioid-Related Outcomes in the United States.","authors":"Victor Puac-Polanco, Stanford Chihuri, David S Fink, Magdalena Cerdá, Katherine M Keyes, Guohua Li","doi":"10.1093/epirev/mxaa002","DOIUrl":"https://doi.org/10.1093/epirev/mxaa002","url":null,"abstract":"<p><p>Prescription drug monitoring programs (PDMPs) are a crucial component of federal and state governments' response to the opioid epidemic. Evidence about the effectiveness of PDMPs in reducing prescription opioid-related adverse outcomes is mixed. We conducted a systematic review to examine whether PDMP implementation within the United States is associated with changes in 4 prescription opioid-related outcome domains: opioid prescribing behaviors, opioid diversion and supply, opioid-related morbidity and substance-use disorders, and opioid-related deaths. We searched for eligible publications in Embase, Google Scholar, MEDLINE, and Web of Science. A total of 29 studies, published between 2009 and 2019, met the inclusion criteria. Of the 16 studies examining PDMPs and prescribing behaviors, 11 found that implementing PDMPs reduced prescribing behaviors. All 3 studies on opioid diversion and supply reported reductions in the examined outcomes. In the opioid-related morbidity and substance-use disorders domain, 7 of 8 studies found associations with prescription opioid-related outcomes. Four of 8 studies in the opioid-related deaths domain reported reduced mortality rates. Despite the mixed findings, emerging evidence supports that the implementation of state PDMPs reduces opioid prescriptions, opioid diversion and supply, and opioid-related morbidity and substance-use disorder outcomes. When PDMP characteristics were examined, mandatory access provisions were associated with reductions in prescribing behaviors, diversion outcomes, hospital admissions, substance-use disorders, and mortality rates. Inconsistencies in the evidence base across outcome domains are due to analytical approaches across studies and, to some extent, heterogeneities in PDMP policies implemented across states and over time.</p>","PeriodicalId":50510,"journal":{"name":"Epidemiologic Reviews","volume":"42 1","pages":"134-153"},"PeriodicalIF":5.5,"publicationDate":"2020-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1093/epirev/mxaa002","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37797959","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}