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Patient characteristics and treatment utilization in fatal stimulant‐involved overdoses in the United States Veterans Health Administration.

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Title: Patient characteristics and treatment utilization in fatal stimulant‐involved overdoses in the United States Veterans Health Administration.
Authors: Coughlin, Lara N. (AUTHOR), Zhang, Lan (AUTHOR), Bohnert, Amy S. B. (AUTHOR), Maust, Donovan T. (AUTHOR), Goldstick, Jason (AUTHOR), Lin, Lewei (AUTHOR)
Source: Addiction. Apr2022, Vol. 117 Issue 4, p998-1008. 11p. 3 Charts, 1 Graph.
Subjects: Narcotics, Substance abuse, Confidence intervals, Drug overdose, Retrospective studies, Methamphetamine, Patients' attitudes, Comparative studies, Death, Odds ratio, Veterans, Medical care of veterans
Geographic Terms: United States
Abstract: Background and Aims: This study aimed to (1) describe trends in stimulant‐alone and stimulant and other substance use overdose deaths from 2012 to 2018 and (2) measure patient and service use characteristics across stimulant‐related overdose death profiles. Design Retrospective cohort study of patients who died from stimulant‐involved overdose between annual years 2012 and 2018. Setting: United States Veterans Health Administration (VHA). A total of 3631 patients died from stimulant‐involved overdose, as identified through the National Death Index. Measurements Stimulant‐involved overdose deaths were categorized by stimulant type (cocaine or methamphetamine/other) and other substance co‐involvement. Cause of death data were linked to patient characteristics, including demographic and treatment use preceding overdose from VHA administrative data. We examined trends over time and compared treatment use factors between the following mutually exclusive overdose profiles: cocaine alone, methamphetamine alone, cocaine + opioid, methamphetamine + opioid, any stimulant + other substance and cocaine + methamphetamine. Findings The rate of overdose death was 3.06 times higher in 2018 than 2012, with increases across all toxicology profiles. Compared with cocaine‐involved overdoses, methamphetamine‐involved overdoses were less likely in people who were older [adjusted odds ratio (aOR) = 0.22, 95% confidence interval (CI) = 0.06–0.87 aged 65+ versus 18–29] and more likely among those who lived in rural areas (aOR = 2.73, 95% CI = 1.43–5.23). People who died from stimulant + opioid overdoses had lower odds of a stimulant use disorder diagnosis compared with stimulant alone deaths (cocaine: aOR = 0.55, 95% CI = 0.41–0.75, methamphetamine: aOR = 0.44, 95% CI = 0.29–0.68). Conclusions: The rate of deaths among US Veterans from stimulant‐related overdose was three times higher in 2018 than 2012. Key differences in characteristics of patients across overdose toxicology profiles, such as geographic location and health‐care use, point to distinct treatment needs based on stimulant use type. [ABSTRACT FROM AUTHOR]
Copyright of Addiction is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
Database: Psychology and Behavioral Sciences Collection
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  Data: Patient characteristics and treatment utilization in fatal stimulant‐involved overdoses in the United States Veterans Health Administration.
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  Data: <searchLink fieldCode="AR" term="%22Coughlin%2C+Lara+N%2E%22">Coughlin, Lara N.</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Zhang%2C+Lan%22">Zhang, Lan</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Bohnert%2C+Amy+S%2E+B%2E%22">Bohnert, Amy S. B.</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Maust%2C+Donovan+T%2E%22">Maust, Donovan T.</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Goldstick%2C+Jason%22">Goldstick, Jason</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Lin%2C+Lewei%22">Lin, Lewei</searchLink> (AUTHOR)
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  Data: <searchLink fieldCode="JN" term="%22Addiction%22">Addiction</searchLink>. Apr2022, Vol. 117 Issue 4, p998-1008. 11p. 3 Charts, 1 Graph.
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  Data: <searchLink fieldCode="DE" term="%22Narcotics%22">Narcotics</searchLink><br /><searchLink fieldCode="DE" term="%22Substance+abuse%22">Substance abuse</searchLink><br /><searchLink fieldCode="DE" term="%22Confidence+intervals%22">Confidence intervals</searchLink><br /><searchLink fieldCode="DE" term="%22Drug+overdose%22">Drug overdose</searchLink><br /><searchLink fieldCode="DE" term="%22Retrospective+studies%22">Retrospective studies</searchLink><br /><searchLink fieldCode="DE" term="%22Methamphetamine%22">Methamphetamine</searchLink><br /><searchLink fieldCode="DE" term="%22Patients'+attitudes%22">Patients' attitudes</searchLink><br /><searchLink fieldCode="DE" term="%22Comparative+studies%22">Comparative studies</searchLink><br /><searchLink fieldCode="DE" term="%22Death%22">Death</searchLink><br /><searchLink fieldCode="DE" term="%22Odds+ratio%22">Odds ratio</searchLink><br /><searchLink fieldCode="DE" term="%22Veterans%22">Veterans</searchLink><br /><searchLink fieldCode="DE" term="%22Medical+care+of+veterans%22">Medical care of veterans</searchLink>
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  Data: <searchLink fieldCode="DE" term="%22United+States%22">United States</searchLink>
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  Label: Abstract
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  Data: Background and Aims: This study aimed to (1) describe trends in stimulant‐alone and stimulant and other substance use overdose deaths from 2012 to 2018 and (2) measure patient and service use characteristics across stimulant‐related overdose death profiles. Design Retrospective cohort study of patients who died from stimulant‐involved overdose between annual years 2012 and 2018. Setting: United States Veterans Health Administration (VHA). A total of 3631 patients died from stimulant‐involved overdose, as identified through the National Death Index. Measurements Stimulant‐involved overdose deaths were categorized by stimulant type (cocaine or methamphetamine/other) and other substance co‐involvement. Cause of death data were linked to patient characteristics, including demographic and treatment use preceding overdose from VHA administrative data. We examined trends over time and compared treatment use factors between the following mutually exclusive overdose profiles: cocaine alone, methamphetamine alone, cocaine + opioid, methamphetamine + opioid, any stimulant + other substance and cocaine + methamphetamine. Findings The rate of overdose death was 3.06 times higher in 2018 than 2012, with increases across all toxicology profiles. Compared with cocaine‐involved overdoses, methamphetamine‐involved overdoses were less likely in people who were older [adjusted odds ratio (aOR) = 0.22, 95% confidence interval (CI) = 0.06–0.87 aged 65+ versus 18–29] and more likely among those who lived in rural areas (aOR = 2.73, 95% CI = 1.43–5.23). People who died from stimulant + opioid overdoses had lower odds of a stimulant use disorder diagnosis compared with stimulant alone deaths (cocaine: aOR = 0.55, 95% CI = 0.41–0.75, methamphetamine: aOR = 0.44, 95% CI = 0.29–0.68). Conclusions: The rate of deaths among US Veterans from stimulant‐related overdose was three times higher in 2018 than 2012. Key differences in characteristics of patients across overdose toxicology profiles, such as geographic location and health‐care use, point to distinct treatment needs based on stimulant use type. [ABSTRACT FROM AUTHOR]
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  Data: <i>Copyright of Addiction is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.</i> (Copyright applies to all Abstracts.)
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        Value: 10.1111/add.15714
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      – Code: eng
        Text: English
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        PageCount: 11
        StartPage: 998
    Subjects:
      – SubjectFull: Narcotics
        Type: general
      – SubjectFull: Substance abuse
        Type: general
      – SubjectFull: Confidence intervals
        Type: general
      – SubjectFull: Drug overdose
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      – SubjectFull: Retrospective studies
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      – SubjectFull: Methamphetamine
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      – SubjectFull: Patients' attitudes
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      – SubjectFull: Comparative studies
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      – SubjectFull: United States
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              Text: Apr2022
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