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Article ; Online: Trends in Psychotropic Drug-Implicated Cardiovascular Mortality: Patterns in U.S. Mortality, 1999-2020.

Kelly, Brian C / Vuolo, Mike

2023 Volume 65, Issue 3, Page(s) 377–384

Abstract: Introduction: Psychotropic drug-implicated (PDI) mortality-deaths in which psychotropic drugs were a contributing but not underlying cause of death-increased over two decades, with circulatory mortality as the primary cause leading to such deaths. ... ...

Abstract	Introduction: Psychotropic drug-implicated (PDI) mortality-deaths in which psychotropic drugs were a contributing but not underlying cause of death-increased over two decades, with circulatory mortality as the primary cause leading to such deaths. Trends in PDI circulatory mortality over a 22-year period and its patterning in U.S. deaths are described. Methods: Deaths extracted from the Centers for Disease Control and Prevention's Wide-ranging Online Data for Epidemiologic Research Multiple Causes of Death database from 1999 to 2020 were analyzed to generate annual counts and rates for drug-implicated deaths due to diseases of the circulatory system, including by specific drug, sex, race/ethnicity, age, and state. Results: During a period when overall age-adjusted circulatory mortality rates declined, PDI circulatory mortality more than doubled, from 0.22 per 100,000 in 1999 to 0.57 per 100,000 by 2020, now representing 1 in 444 circulatory deaths. Although PDI deaths from ischemic heart diseases are proportionally aligned with overall circulatory deaths (50.0% vs 48.5%), PDI deaths from hypertensive diseases represent a larger proportion (19.8% vs 8.0%). Psychostimulants generated the greatest escalation for PDI circulatory deaths (0.029-0.332 per 100,000). The sex gap in PDI mortality rates widened (0.291 females, 0.861 males). PDI circulatory mortality is particularly notable for Black Americans and midlife Americans, with considerable geographic variability. Conclusions: Circulatory mortality with psychotropic drugs as a contributing cause escalated over 2 decades. Trends in PDI mortality are not evenly distributed across the population. Greater engagement with patients about their substance use is needed to intervene in cardiovascular deaths. Prevention and clinical intervention could contribute to reinvigorating previous trends of declining cardiovascular mortality.
MeSH term(s)	Female ; Humans ; Male ; Black or African American ; Cause of Death ; Hypertension/mortality ; Psychotropic Drugs/adverse effects ; United States/epidemiology ; Cardiovascular Diseases/mortality
Chemical Substances	Psychotropic Drugs
Language	English
Publishing date	2023-03-07
Publishing country	Netherlands
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	632646-8
ISSN	1873-2607 ; 0749-3797
ISSN (online)	1873-2607
ISSN	0749-3797
DOI	10.1016/j.amepre.2023.02.016
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Article ; Online: Predictors of concurrent heroin use among patients on opioid maintenance treatment in France: a multilevel study over 11 years.

Janssen, Eric / Vuolo, Mike / Spilka, Stanislas / Airagnes, Guillaume

Harm reduction journal

2024 Volume 21, Issue 1, Page(s) 15

Abstract: Background: Consistent reports from health professionals suggest that heroin is commonly used by patients undergoing opioid maintenance treatment (OMT) in France, potentially jeopardizing their recovery process. However, there has been no formal ... ...

Abstract	Background: Consistent reports from health professionals suggest that heroin is commonly used by patients undergoing opioid maintenance treatment (OMT) in France, potentially jeopardizing their recovery process. However, there has been no formal epidemiological assessment on the matter. Methods: We use a yearly updated compendium retrieving information on patients admitted in treatment centres in France between 2010 and 2020. Given the hierarchical nature of the data collection, we conduct 2-level modified Poisson regressions to estimate the risks of past month heroin use among patients on OMT. Results: Despite an overall decreasing trend over time, heroin use among patients on OMT is indeed common, with half of patients declaring concurrent use. Our study unveils differentiated risks of heroin use vary according to the type of OMT, with patients on methadone more likely to use heroin compared to those on buprenorphine. The use of multilevel-related measures also uncovers high heterogeneity among patients' profiles, reflecting different stages in the treatment process, as well as differentiated practices across treatment centres. Conclusion: Opioid maintenance treatment is associated with heroin use, in particular when methadone is involved. The heterogeneity among patients on OMT should be given particular attention, as it underscores the need for tailored interventions.
MeSH term(s)	Humans ; Opiate Substitution Treatment ; Heroin/therapeutic use ; Opioid-Related Disorders/complications ; Opioid-Related Disorders/epidemiology ; Opioid-Related Disorders/drug therapy ; Buprenorphine/therapeutic use ; Methadone/therapeutic use ; Analgesics, Opioid/therapeutic use
Chemical Substances	Heroin (70D95007SX) ; Buprenorphine (40D3SCR4GZ) ; Methadone (UC6VBE7V1Z) ; Analgesics, Opioid
Language	English
Publishing date	2024-01-19
Publishing country	England
Document type	Journal Article
ZDB-ID	2146691-9
ISSN	1477-7517 ; 1477-7517
ISSN (online)	1477-7517
ISSN	1477-7517
DOI	10.1186/s12954-024-00934-x
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Article ; Online: Later-life transitions and changes in prescription medication use for pain and depression.

Lam, Jack / Vuolo, Mike

BMC geriatrics

2022 Volume 22, Issue 1, Page(s) 222

Abstract: Background: Over the past two decades, prescription medication use for pain and depression increased dramatically. Most studies consider the early life course, despite a similar increase among those in later life. In this paper, we examine whether and ... ...

Abstract	Background: Over the past two decades, prescription medication use for pain and depression increased dramatically. Most studies consider the early life course, despite a similar increase among those in later life. In this paper, we examine whether and how later life transitions may relate to changes in medication use. Methods: We draw on data from the Health and Retirement Study and fixed-effects models to examine whether work, family, and civic transitions in later life are related to changes in the usage of prescription pain and depression medication. Results: Results show that individuals had higher odds of regularly using prescription pain and depression medications in periods when out of the labor market. Higher odds of depression medication use were also associated with periods of widowhood, and lower odds of use when frequently volunteering. Such relations persist adjusting for reported levels of pain and depression. Conclusion: Our findings call attention to the importance of social ties and the presence of actors that may regulate health behaviors, as well as a change in social context, that may shape medication use in later life.
MeSH term(s)	Depression/drug therapy ; Depression/epidemiology ; Humans ; Pain/drug therapy ; Pain/epidemiology ; Prescription Drugs/therapeutic use ; Prescriptions ; Retirement
Chemical Substances	Prescription Drugs
Language	English
Publishing date	2022-03-17
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2059865-8
ISSN	1471-2318 ; 1471-2318
ISSN (online)	1471-2318
ISSN	1471-2318
DOI	10.1186/s12877-022-02921-y
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Article ; Online: Correlates of Heroin Use, Pharmaceutical Fentanyl Misuse, and Dual Heroin-Fentanyl Use: Evidence from the U.S.

Kelly, Brian C / Vuolo, Mike

Drugs, habits and social policy

2022 Volume 24, Issue 1, Page(s) 14–25

Abstract: Purpose: The emergence of fentanyl has deepened concerns about the opioid crisis. The shift has created new distinctions in patterns of opioid use, which may be important for prevention and intervention. We examine socio-demographic correlates as well ... ...

Abstract	Purpose: The emergence of fentanyl has deepened concerns about the opioid crisis. The shift has created new distinctions in patterns of opioid use, which may be important for prevention and intervention. We examine socio-demographic correlates as well as health and substance use characteristics of different groups of opioid users. Design: We utilized the 2015-2019 National Survey on Drug Use and Health to examine distinctions between groups (n=11,142) of individuals who misuse prescription opioids, use heroin but not fentanyl, misuse pharmaceutical fentanyl but not heroin, and use both heroin and fentanyl. Multinomial and logistic regression models were used to identify these distinctions. Findings: Few socio-demographic differences emerged between the prescription opioid group and pharmaceutical fentanyl misuse group. While those who misuse fentanyl have higher odds of using other drugs and experiencing certain mental health problems than those misusing prescription pills, both the heroin and fentanyl-heroin use groups reported considerably poorer health and substance use indicators relative to those who solely misuse fentanyl. It is also notable that both heroin use groups are more highly associated with cocaine and methamphetamine use than those misusing fentanyl alone. Originality: This study highlights distinctions between pharmaceutical fentanyl users, heroin users, and users of both substances. Implications: While we identify important distinctions between the opioid use groups studied, individuals using both heroin and pharmaceutical fentanyl report the poorest health and substance use characteristics. Important differences between the fentanyl-only group and the group who consume both drugs may have implications for prevention, intervention, and clinical work amidst shifting patterns of opioid use.
Language	English
Publishing date	2022-09-22
Publishing country	England
Document type	Journal Article
ISSN	2752-6747
ISSN (online)	2752-6747
DOI	10.1108/dhs-04-2022-0019
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Article ; Online: Policy Brief.

Vuolo, Mike / Frizzell, Laura C / Kelly, Brian C

Journal of health and social behavior

2022 Volume 63, Issue 3, Page(s) 336

MeSH term(s)	Health Policy ; Humans
Language	English
Publishing date	2022-08-30
Publishing country	United States
Document type	Journal Article
ZDB-ID	218206-3
ISSN	2150-6000 ; 0022-1465
ISSN (online)	2150-6000
ISSN	0022-1465
DOI	10.1177/00221465221112986
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Article ; Online: Developing explanatory models for life course shifts in the burden of substance use to inform future policy and practice.

Kelly, Brian C / Vuolo, Mike

The International journal on drug policy

2021 Volume 94, Page(s) 103182

Abstract: Past approaches to policy and practice for substance use have focused heavily on young people, but recent trends indicate this approach may not be where the future lies. The crises with escalating overdose mortality in several countries, particularly ... ...

Abstract	Past approaches to policy and practice for substance use have focused heavily on young people, but recent trends indicate this approach may not be where the future lies. The crises with escalating overdose mortality in several countries, particularly overdoses related to opioids, have drawn attention to life course shifts in the burdens of substance use. Overdose mortality rates for individuals in midlife have considerably outpaced those of adolescents and individuals in early adulthood. These diverging life course trends are occurring not only in the United States, but in other countries with growing overdose problems as well. The future of effective policy and practice depend upon evidence and analyses that adapt to emerging data on shifting life course trends in drug related mortality. Within this manuscript, we consider a range of theoretical possibilities on the divergence of midlife drug mortality trends from those of young people for the purpose of outlining an agenda for future research and practice. Specifically, we consider the following theoretical approaches to move research forward in this area: Changes in Medical Context hypothesis; Emergent Comorbidities hypothesis; Cohort hypothesis; Generational Forgetting hypothesis; Legal Regulation hypothesis; Strength of Life Course Bonds hypothesis; Deepening Inequality hypothesis; Measurement Reliability hypothesis. These theoretical frameworks attend specifically to the overdose crisis but extend to other aspects of substance use. Beyond setting an agenda for research by providing empirically verifiable hypotheses, this manuscript also identifies future directions in policy and practice that are attentive to life course trends.
MeSH term(s)	Adolescent ; Adult ; Analgesics, Opioid/therapeutic use ; Drug Overdose/drug therapy ; Drug Overdose/epidemiology ; Humans ; Policy ; Reproducibility of Results ; Substance-Related Disorders/drug therapy ; Substance-Related Disorders/epidemiology ; United States/epidemiology
Chemical Substances	Analgesics, Opioid
Language	English
Publishing date	2021-03-06
Publishing country	Netherlands
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	2010000-0
ISSN	1873-4758 ; 0955-3959
ISSN (online)	1873-4758
ISSN	0955-3959
DOI	10.1016/j.drugpo.2021.103182
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Article ; Online: Do naloxone access laws affect perceived risk of heroin use? Evidence from national US data.

Kelly, Brian C / Vuolo, Mike

Addiction (Abingdon, England)

2021 Volume 117, Issue 3, Page(s) 666–676

Abstract: Background and aims: Whether expanded access to naloxone reduces perceptions of risk about opioid use has been subject to debate. Our aim was to assess how implementation of naloxone access laws shapes perceived risk of heroin use.: Design: Using ... ...

Abstract	Background and aims: Whether expanded access to naloxone reduces perceptions of risk about opioid use has been subject to debate. Our aim was to assess how implementation of naloxone access laws shapes perceived risk of heroin use. Design: Using data from the restricted-access National Survey on Drug Use and Health, Prescription Drug Abuse Policy System and the US Census, we applied two-way fixed-effects models to determine whether naloxone access laws decreased perceived risk of any heroin use or regular heroin use. We used Bayes factors (BFs) to confirm evidence for null findings. Setting: United States. Participants: A total of 884 800 respondents aged 12 and older from 2004 to 2016. Measurements: A binary indicator of whether a state implemented naloxone access laws was regressed on respondent-perceived risk of (1) any heroin use and (2) regular heroin use. Ratings of perceived risk were assessed on a scale of 1 (none) to 4 (great risk). Findings: In all instances, the BFs support evidence for the null hypothesis. Across models with three distinct specifications of naloxone access laws, we found no evidence of decreased risk perceptions, as confirmed by BFs ranging from 0.009 to 0.057. Across models of specific vulnerable subgroups, such as people who use opioids (BFs = 0.039-0.225) or young people (BFs = 0.009-0.158), we found no evidence of decreased risk perceptions. Across diverse subpopulations by gender (BFs = 0.011-0.083), socio-economic status (BFs = 0.015-0.168) or race/ethnicity (BFs = 0.016-0.094), we found no evidence of decreased risk perceptions. Conclusions: There appears to be no empirical evidence that implementation of naloxone access laws has adversely affected perceptions of risk of heroin in the broader US population or within vulnerable subgroups or diverse subpopulations.
MeSH term(s)	Adolescent ; Analgesics, Opioid/therapeutic use ; Bayes Theorem ; Drug Overdose/drug therapy ; Drug Overdose/epidemiology ; Heroin/therapeutic use ; Humans ; Naloxone/therapeutic use ; Narcotic Antagonists/therapeutic use ; Opioid-Related Disorders/drug therapy ; Opioid-Related Disorders/epidemiology ; United States/epidemiology
Chemical Substances	Analgesics, Opioid ; Narcotic Antagonists ; Naloxone (36B82AMQ7N) ; Heroin (70D95007SX)
Language	English
Publishing date	2021-10-06
Publishing country	England
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	1141051-6
ISSN	1360-0443 ; 0965-2140
ISSN (online)	1360-0443
ISSN	0965-2140
DOI	10.1111/add.15682
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Article ; Online: Effects of County-Level Opioid Dispensing Rates on Individual-Level Patterns of Prescription Opioid and Heroin Consumption: Evidence From National U.S. Data.

Vuolo, Mike / Kelly, Brian C

The American journal of psychiatry

2021 Volume 179, Issue 4, Page(s) 305–311

Abstract: Objective: The authors examined directly whether county-level changes in opioid dispensing rates affect individual-level prescription opioid misuse, frequency of use, and dependence, as well as the same outcomes for heroin.: Methods: Using data from ... ...

Abstract	Objective: The authors examined directly whether county-level changes in opioid dispensing rates affect individual-level prescription opioid misuse, frequency of use, and dependence, as well as the same outcomes for heroin. Methods: Using data from the restricted-access National Survey on Drug Use and Health, the Centers for Disease Control and Prevention's retail opioid prescription database, the Prescription Drug Abuse Policy System, and the U.S. Census, the authors applied fixed-effects models to determine whether county-level dispensing rates affected prescription opioid outcomes as intended and whether changes in rates adversely affected heroin use outcomes. Bayes factors were used to confirm evidence for null findings. Results: The sample included 748,800 respondents age 12 and older from 2006 to 2016. The odds of prescription opioid misuse, increased frequency of misuse, and dependence were 7.2%, 3.5%, and 10.4% higher, respectively, per standard deviation increase in the county-level opioid dispensing rate per 100 persons. There was no evidence for any association between opioid dispensing rates and the three heroin outcomes. The odds ratio was nonsignificant according to frequentist techniques in fixed-effects models, and Bayesian techniques confirmed very strong support for the null hypothesis. Conclusions: County-level opioid dispensing rates are directly associated with individual-level prescription opioid misuse, frequency of misuse, and dependence. Changes in dispensing were not associated with population shifts in heroin use. Reductions in opioid dispensing rates have contributed to stemming prior increases in prescription opioid misuse while not adversely affecting heroin use. Physicians and other health care providers can take action to minimize opioid dispensing for tangible benefits regarding prescription opioid misuse without adverse effects on heroin use.
MeSH term(s)	Analgesics, Opioid/therapeutic use ; Bayes Theorem ; Child ; Heroin/therapeutic use ; Humans ; Opioid-Related Disorders/drug therapy ; Opioid-Related Disorders/epidemiology ; Prescription Drug Misuse/prevention & control ; Prescriptions ; United States/epidemiology
Chemical Substances	Analgesics, Opioid ; Heroin (70D95007SX)
Language	English
Publishing date	2021-12-08
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	280045-7
ISSN	1535-7228 ; 0002-953X
ISSN (online)	1535-7228
ISSN	0002-953X
DOI	10.1176/appi.ajp.2021.21060602
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Article ; Online: Comprehensive vaping bans are associated with lower odds of initiation into electronic nicotine delivery systems use among young people.

Vuolo, Mike / Orsini, Maria M / Staff, Jeremy / Maggs, Jennifer L / Kelly, Brian C

Addiction (Abingdon, England)

2024

Abstract: Background and aims: E-cigarette and other electronic nicotine delivery systems (ENDS) use has grown considerably over the past decade, with notable increases among young people. US state policy contexts for ENDS and tobacco may shape initiation into ... ...

Abstract	Background and aims: E-cigarette and other electronic nicotine delivery systems (ENDS) use has grown considerably over the past decade, with notable increases among young people. US state policy contexts for ENDS and tobacco may shape initiation into ENDS use among adolescents as they age into early adulthood. We aimed to determine whether state-level comprehensive vaping ban policies reduce the odds of youth initiation into ENDS use, net of additional state-level ENDS and tobacco policies, as well as the youth's cigarette smoking status. Design: Longitudinal data from the Population Assessment of Tobacco and Health study were merged with a state-year database on tobacco and ENDS policies. Multivariable discrete-time event history models of ENDS initiation were estimated. Setting: United States. Participants: Twenty thousand twelve youth assessed over six waves from 2013 to 2019 (n = 53 974 observations). Measurement: We examined comprehensive indoor vaping bans (i.e. 100% vape-free workplaces, restaurants and bars) as a key factor in initiation into ENDS use (i.e. first instance of vaping) from age 13 to 22. Findings: Among young people, residing in a state with a comprehensive vaping ban was associated with 18% lower odds of ENDS initiation (odds ratio = 0.82; 95% confidence interval =[0.71, 0.94]), even after controlling for other state ENDS and tobacco policies, the youth's cigarette smoking and socio-demographic background and state-level covariates. Conclusions: In the United States, state-level vaping bans (i.e. 100% vape-free workplaces, restaurants and bars) are associated with reduced odds of youth initiation into electronic nicotine delivery systems use.
Language	English
Publishing date	2024-02-27
Publishing country	England
Document type	Journal Article
ZDB-ID	1141051-6
ISSN	1360-0443 ; 0965-2140
ISSN (online)	1360-0443
ISSN	0965-2140
DOI	10.1111/add.16450
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Article ; Online: E-cigarette use among early adolescent tobacco cigarette smokers: testing the disruption and entrenchment hypotheses in two longitudinal cohorts.

Kelly, Brian C / Vuolo, Mike / Maggs, Jennifer / Staff, Jeremy

Tobacco control

2023

Abstract: Objective: Using longitudinal data from two large-scale cohorts in the UK and USA, we examine whether e-cigarette use steers adolescent early smokers away from tobacco cigarettes (disruption hypothesis) or deepens early patterns of tobacco smoking ( ... ...

Abstract	Objective: Using longitudinal data from two large-scale cohorts in the UK and USA, we examine whether e-cigarette use steers adolescent early smokers away from tobacco cigarettes (disruption hypothesis) or deepens early patterns of tobacco smoking (entrenchment hypothesis) in comparison with early smokers who do not use e-cigarettes. Methods: Youth who smoked tobacco cigarettes by early adolescence (before age 15) were selected from the ongoing UK Millennium Cohort Study (n=1090) and the US Population Assessment of Tobacco and Health (n=803) study. In regression models, the focal predictor was lifetime use of an e-cigarette by early adolescence and the primary outcome was current tobacco use by late adolescence (before age 18). Logistic and multinomial models controlled for early adolescent risk factors and sociodemographic background, and were weighted for attrition and adjusted for complex survey designs. Results: Among youth who were early cigarette smokers, 57% of UK and 58% of US youth also used e-cigarettes. The odds of later adolescent smoking among early smoking youth were significantly higher among e-cigarette users relative to those who had not used e-cigarettes (adjusted OR (AOR Conclusions: Despite national differences in e-cigarette regulation and marketing, there is evidence e-cigarette use among early adolescent smokers in the UK and USA leads to higher odds of any smoking and more frequent tobacco cigarette use later in adolescence.
Language	English
Publishing date	2023-04-18
Publishing country	England
Document type	Journal Article
ZDB-ID	1146554-2
ISSN	1468-3318 ; 0964-4563
ISSN (online)	1468-3318
ISSN	0964-4563
DOI	10.1136/tc-2022-057717
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