Grant T. Baldwin

Relationship between Nonmedical Prescription-Opioid Use and Heroin Use

A large fraction of heroin users now report that they formerly used prescription opioids nonmedically, a finding that has led to restrictions on opioid prescribing. Nevertheless, only a small fraction of prescription-opioid users move on to heroin use.

National and State Treatment Need and Capacity for Opioid Agonist Medication-Assisted Treatment

OBJECTIVES We estimated national and state trends in opioid agonist medication-assisted treatment (OA-MAT) need and capacity to identify gaps and inform policy decisions. METHODS We generated national and state rates of past-year opioid abuse or dependence, maximum potential buprenorphine treatment capacity, number of patients receiving methadone from opioid treatment programs (OTPs), and the percentage of OTPs operating at 80% capacity or more using Substance Abuse and Mental Health Services Administration data. RESULTS Nationally, in 2012, the rate of opioid abuse or dependence was 891.8 per 100 000 people aged 12 years or older compared with national rates of maximum potential buprenorphine treatment capacity and patients receiving methadone in OTPs of, respectively, 420.3 and 119.9. Among states and the District of Columbia, 96% had opioid abuse or dependence rates higher than their buprenorphine treatment capacity rates; 37% had a gap of at least 5 per 1000 people. Thirty-eight states (77.6%) reported at least 75% of their OTPs were operating at 80% capacity or more. CONCLUSIONS Significant gaps between treatment need and capacity exist at the state and national levels. Strategies to increase the number of OA-MAT providers are needed.

Application of Health Promotion Theories and Models for Environmental Health

The field of environmental health promotion gained new prominence in recent years as awareness of physical environmental stressors and exposures increased in communities across the country and the world. Although many theories and conceptual models are used routinely to guide health promotion and health education interventions, they are rarely applied to environmental health issues. This article examine show health promotion theories and models can be applied in designing interventions to reduce exposure to environmental health hazards. Using the Community Action Against Asthma (CAAA) project as an example, this article describes the application of these theories and models to an intervention aimed at reducing environmental triggers for childhood asthma. Drawing on the multiple theories and models described, a composite ecological stress process model is presented, and its implications for environmental health promotion discussed.

An Older Adult Falls Research Agenda from a Public Health Perspective

This article reviews fall prevention research using the Centers for Disease Control public health model and suggests several critical research questions at each step. Research topics include surveillance and data systems, fall risk factors, development, evaluation and implementation of fall interventions, translation of interventions into programs, and promotion, dissemination, and widespread adoption of fall prevention programs. These broad topics provide a framework for research that can guide future advances in older adult fall prevention.

The CDC Injury Center’s response to the growing public health problem of falls among older adults

Background. Older adult falls are a significant cause of morbidity and mortality in the United States. This leading cause of injury in adults aged 65 and older results in

Recent increases in cocaine-related overdose deaths and the role of opioids

35 billion in direct medical costs. Objective. To project the number of older adult falls by 2030 and the associated lifetime medical cost. A secondary objective is to review what clinicians can do to incorporate falls screening and prevention into their practice for community-dwelling older adults. Methods. Using the Centers for Disease Control and Prevention’s Web-based Injury Statistics Query and Reporting System and the US Census Bureau data, the number of older adults in 2030, fatal falls, and medical costs associated with fall injuries was projected. In addition, evidence-based interventions that can be integrated into clinical practice were reviewed. Results. The number of older adult fatal falls is projected to reach 100 000 per year by 2030 with an associated cost of

Vital Signs: Motor Vehicle Injury Prevention — United States and 19 Comparison Countries

100 billion. By integrating screening for falls risk into clinical practice, reviewing and modifying medications, and recommending vitamin D supplementation, physicians can reduce future falls by nearly 25%. Conclusion. Falls in older adults will continue to rise substantially and become a significant cost to our health care system if we do not begin to focus on prevention in the clinical setting.

Contribution of Opioid-Involved Poisoning to the Change in Life Expectancy in the United States, 2000-2015

Objectives To assess trends in cocaine overdose deaths and examine the role opioids play in these deaths. Methods We used data on drug overdose deaths in the United States from 2000 to 2015 collected in the National Vital Statistics System to calculate annual rates and numbers of cocaine-related overdose deaths overall and deaths both involving and not involving opioids. We assessed statistically significant changes in trends with joinpoint regression. Results Rates of cocaine-related overdose deaths increased significantly from 1.26 to 2.50 per 100 000 population from 2000 to 2006, declined to 1.35 in 2010, and increased to 2.13 in 2015. Cocaine-related overdose deaths involving opioids increased from 0.37 to 0.91 from 2000 to 2006, declined to 0.57 in 2010, and then increased to 1.36 in 2015. Cocaine-related overdose deaths not involving opioids increased from 0.89 to 1.59 from 2000 to 2006 and then declined to 0.78 in 2015. Conclusions Opioids, primarily heroin and synthetic opioids, have been driving the recent increase in cocaine-related overdose deaths. This corresponds to the growing supply and use of heroin and illicitly manufactured fentanyl in the United States.

Trends in Methadone Distribution for Pain Treatment, Methadone Diversion, and Overdose Deaths - United States, 2002-2014.

BACKGROUND Each year >32,000 deaths and 2 million nonfatal injuries occur on U.S. roads. METHODS CDC analyzed 2000 and 2013 data compiled by the World Health Organization and the Organisation for Economic Co-operation and Development (OECD) to determine the number and rate of motor vehicle crash deaths in the United States and 19 other high-income OECD countries and analyzed estimated seat belt use and the percentage of deaths that involved alcohol-impaired driving or speeding, by country. RESULTS In 2013, the United States motor vehicle crash death rate of 10.3 per 100,000 population had decreased 31% from the rate in 2000; among the 19 comparison countries, the rate had declined an average of 56% during this time. Among all 20 countries, the United States had the highest rate of crash deaths per 100,000 population (10.3); the highest rate of crash deaths per 10,000 registered vehicles (1.24), and the fifth highest rate of motor vehicle crash deaths per 100 million vehicle miles traveled (1.10). Among countries for which information on national seat belt use was available, the United States ranked 18th out of 20 for front seat use, and 13th out of 18 for rear seat use. Among 19 countries, the United States reported the second highest percentage of motor vehicle crash deaths involving alcohol-impaired driving (31%), and among 15, had the eighth highest percentage of crash deaths that involved speeding (29%). CONCLUSIONS AND COMMENTS Motor vehicle injuries are predictable and preventable. Lower death rates in other high-income countries, as well as a high prevalence of risk factors in the United States, suggest that the United States can make more progress in reducing crash deaths. With a projected increase in U.S. crash deaths in 2015, the time is right to reassess U.S. progress and set new goals. By implementing effective strategies, including those that increase seat belt use and reduce alcohol-impaired driving and speeding, the United States can prevent thousands of motor vehicle crash-related injuries and deaths and hundreds of millions of dollars in direct medical costs every year.

Using baseline and formative evaluation data to inform the Uganda Helmet Vaccine Initiative

Contribution of Opioid-Involved Poisoning to the Change in Life Expectancy in the United States, 2000-2015 Drug poisoning mortality more than doubled in the United States from 2000 to 2015; poisoning mortality involving opioids more than tripled.1,2 Increases in poisonings have been reported to have reduced life expectancy for non-Hispanic white individuals in the United States from 2000 to 2014.3 Specific contributions of drug, opioid, and alcohol poisonings to changes in US life expectancy since 2000 are unknown.