2024
Using qualitative system dynamics modeling to understand overdose bystander behavior in the context of Connecticut’s Good Samaritan Laws and identify effective policy options
Thompson R, Sabounchi N, Ali S, Heimer R, D’Onofrio G, Heckmann R. Using qualitative system dynamics modeling to understand overdose bystander behavior in the context of Connecticut’s Good Samaritan Laws and identify effective policy options. Harm Reduction Journal 2024, 21: 124. PMID: 38937759, PMCID: PMC11210010, DOI: 10.1186/s12954-024-00990-3.Peer-Reviewed Original ResearchConceptsSamaritan lawsGood Samaritan lawsBystander behaviorGroup model buildingFear of legal consequencesKnowledge of protectionResponses to opioid overdosesCriminal liabilityDrug arrestsLegal consequencesLaw enforcementNaloxone useLawStakeholder-engaged processOpioid overdoseHealth care providersFatal opioid overdoseSustainable system changeOpioid-related outcomesBystander experiencesSamaritanCare providersHarm reductionPotential bystandersPolicy determinationAccessibility of Opioid Treatment Programs Based on Conventional vs Perceived Travel Time Measures
Kim J, Lee J, Thornhill T, Dennett J, Lu H, Howell B, Grau L, Fiellin D, Heimer R, Gonsalves G. Accessibility of Opioid Treatment Programs Based on Conventional vs Perceived Travel Time Measures. JAMA Network Open 2024, 7: e240209. PMID: 38376839, PMCID: PMC10879949, DOI: 10.1001/jamanetworkopen.2024.0209.Peer-Reviewed Original ResearchConceptsTransit travel timeAccessibility metricsTravel timeTravel componentsAccessibility scoresTransportation burdenTravel burdenOut-of-vehicleComponents of travelConventional accessibility measuresSpatial regression modelsTravel time measurementsPublic transitTransit schedulesAccessibility measuresDeparture timeTravel time analysisTrip durationTravelOperating hoursTime analysisCross-sectional studyOpioid use disorderPolicy recommendationsDecision-making
2023
Receipt of opioid use disorder treatments prior to fatal overdoses and comparison to no treatment in Connecticut, 2016–17
Heimer R, Black A, Lin H, Grau L, Fiellin D, Howell B, Hawk K, D'Onofrio G, Becker W. Receipt of opioid use disorder treatments prior to fatal overdoses and comparison to no treatment in Connecticut, 2016–17. Drug And Alcohol Dependence 2023, 254: 111040. PMID: 38043226, PMCID: PMC10872282, DOI: 10.1016/j.drugalcdep.2023.111040.Peer-Reviewed Original ResearchConceptsNon-medication treatmentsRelative riskOpioid overdose deathsIncidence rateMOUD treatmentOverdose deathsOpioid use disorder treatmentResults Incidence ratesRetrospective cohort studyDifferent treatment modalitiesPopulation-level effortsUse disorder treatmentFatal opioid poisoningsCohort studyOpioid poisoningTreatment modalitiesConclusion ExposurePoisoning deathsFatal overdosesTreatment exposureDisorder treatmentDeathTreatmentMethadoneRisk“It’s starting to weigh on me”: Exploring the Experiences and Support Needs of Harm Reduction Staff in Connecticut using the Social-Ecological Model
Hill K, Dunham K, Grau L, Heimer R. “It’s starting to weigh on me”: Exploring the Experiences and Support Needs of Harm Reduction Staff in Connecticut using the Social-Ecological Model. Harm Reduction Journal 2023, 20: 168. PMID: 37964261, PMCID: PMC10644636, DOI: 10.1186/s12954-023-00898-4.Peer-Reviewed Original ResearchConceptsSocial ecological modelSupport needsHarm reduction workersHarm reduction programmingHarm reduction servicesThematic analysis approachProvision of supportStigmatized populationsMeans of supportReduction workersInterpersonal levelCommunity levelHarm reductionDay roleReduction servicesOverdose crisisReduction programmingStaff wellbeingRole-related stressorsRole-related stressFeelings of stressBoundary settingEmotional supportPotential supportIndividual levelTechnical violations and infractions are drivers of disengagement from methadone treatment among people with opioid use disorder discharged from Connecticut jails 2014–2018
Marotta P, Hass A, Viera A, Doernberg M, Barbour R, Grau L, Heimer R. Technical violations and infractions are drivers of disengagement from methadone treatment among people with opioid use disorder discharged from Connecticut jails 2014–2018. Substance Abuse Treatment, Prevention, And Policy 2023, 18: 43. PMID: 37420271, PMCID: PMC10329353, DOI: 10.1186/s13011-023-00541-2.Peer-Reviewed Original ResearchConcordance between controlled substance receipt and post-mortem toxicology in opioid-detected overdose deaths: A statewide analysis
Howell B, Black A, Grau L, Lin H, Greene C, Lee H, Heimer R, Hawk K, D'Onofrio G, Fiellin D, Becker W. Concordance between controlled substance receipt and post-mortem toxicology in opioid-detected overdose deaths: A statewide analysis. Drug And Alcohol Dependence 2023, 244: 109788. PMID: 36738634, PMCID: PMC9975083, DOI: 10.1016/j.drugalcdep.2023.109788.Peer-Reviewed Original ResearchConceptsPost-mortem toxicologyOverdose deathsChief Medical ExaminerBenzodiazepine prescribingBenzodiazepine prescriptionsPrimary outcomePreventable deathsOpioid overdosesOpioidsAddiction servicesBenzodiazepinesMental healthStudy periodDeathMedical examinersConcordanceStatewide analysisSubstantial numberReceiptDaysDepartmentMedicationsToxicologyFentanylPrescribing
2022
Impact of prerelease methadone on mortality among people with HIV and opioid use disorder after prison release: results from a randomized and participant choice open-label trial in Malaysia
Bazazi A, Culbert G, Wegman M, Heimer R, Kamarulzaman A, Altice F. Impact of prerelease methadone on mortality among people with HIV and opioid use disorder after prison release: results from a randomized and participant choice open-label trial in Malaysia. BMC Infectious Diseases 2022, 22: 837. PMID: 36368939, PMCID: PMC9652918, DOI: 10.1186/s12879-022-07804-6.Peer-Reviewed Original ResearchConceptsOpioid use disorderOpioid agonist therapyInfectious etiologyMost deathsUse disordersSample of menPrison releaseOpen-label trialT-lymphocyte countsPredictors of mortalityNational death recordsCrude mortality rateProportional hazards modelCovariate-adjusted modelsLow CD4Methadone initiationModified intentionAgonist therapySurvival benefitTreat analysisMethodsThis studyHIVHazards modelMortality rateMethadone
2020
Physician and patient prediction of adherence to antiretroviral therapy in HIV positive people in Saint-Petersburg, Russia
Vetrova M, Aleksandrova O, Paschenko A, Toropov S, Rassokhin V, Abyshev R, Levina O, Niccolai L, Heimer R. Physician and patient prediction of adherence to antiretroviral therapy in HIV positive people in Saint-Petersburg, Russia. AIDS Care 2020, 33: 473-477. PMID: 32148065, DOI: 10.1080/09540121.2020.1738005.Peer-Reviewed Original ResearchConceptsAntiretroviral therapyHIV-positive peopleART initiationPositive peopleHIV viral suppressionPatient predictionsAccuracy of providerReview of pharmacyART retentionHIV physiciansViral suppressionPhysicians' predictionsTreatment outcomesART outcomesPatientsAdherenceLaboratory dataTherapyLongitudinal analysisOutcomesProvidersInitiationPhysiciansCare
2018
Early stages of HIV treatment cascade in people living with HIV in Saint-Petersburg, Russia
Vetrova M, Aleksandrova O, Paschenko A, Toropov S, Rassokhin V, Abyshev R, Levina O, Niccolai L, Heimer R. Early stages of HIV treatment cascade in people living with HIV in Saint-Petersburg, Russia. AIDS Care 2018, 30: 857-862. PMID: 29325435, DOI: 10.1080/09540121.2017.1417536.Peer-Reviewed Original ResearchConceptsAntiretroviral therapyUndetectable VLART outcomesInitiation of ARTPilot studyProportion of PLWHMedical chart reviewHIV epidemic controlSuccessful treatment outcomeProportion of peopleChart reviewHIV treatmentDrug abuse statusDisease progressionTreatment outcomesOlder ageTreatment effectivenessART effectivenessEpidemic controlPLWHIllicit drugsHIVSignificant differencesAbuse statusOutcomes
2016
Psychiatric Distress, Drug Use, and HIV Viral Load Suppression in Russia
Ustinov A, Suvorova A, Belyakov A, Makhamatova A, Levina O, Krupitsky E, Lioznov D, Niccolai L, Heimer R. Psychiatric Distress, Drug Use, and HIV Viral Load Suppression in Russia. AIDS And Behavior 2016, 20: 1603-1608. PMID: 26809193, PMCID: PMC4945434, DOI: 10.1007/s10461-016-1297-x.Peer-Reviewed Original Research
2012
Speaking the truth: an analysis of gender differences in serostatus disclosure practices among HIV-infected patients in St Petersburg, Russia
Davidson A, Zaller N, Dukhovlinova E, Toussova O, Feller E, Heimer R, Kozlov A. Speaking the truth: an analysis of gender differences in serostatus disclosure practices among HIV-infected patients in St Petersburg, Russia. International Journal Of STD & AIDS 2012, 23: 685-688. PMID: 23104740, DOI: 10.1258/ijsa.2012.011463.Peer-Reviewed Original ResearchConceptsInjection drug useHIV treatmentDrug useRussian HIV epidemicCross-sectional studyHIV-positive serostatusHeterosexual spreadHIV diseaseSecondary preventionAIDS CenterAIDS clinicMean ageSexual transmissionHIV epidemicSerostatus disclosureFemale genderImportant target groupMarried statusInfection routeSexual partnersHIVPatientsImportant contact pointsMedical communityMode of acquisition
2011
Chronic pain, Addiction severity, and misuse of opioids in Cumberland County, Maine
Heimer R, Dasgupta N, Irwin KS, Kinzly M, Harvey AP, Givens A, Grau LE. Chronic pain, Addiction severity, and misuse of opioids in Cumberland County, Maine. Addictive Behaviors 2011, 37: 346-349. PMID: 22138379, DOI: 10.1016/j.addbeh.2011.11.017.Peer-Reviewed Original ResearchConceptsAddiction Severity IndexBrief Pain InventoryChronic painOpioid abuseBPI scoresMisuse of opioidsCommon co-occurring conditionsSubstance abuse treatment programsCommunity-based sampleCo-occurring conditionsSubstance abuse treatmentStreet-recruited sampleOrder of onsetRespondent-driven samplingPain InventoryPain managementIllicit opioidsOpioid misuseRegular physicianOpioid abusersDaily livingPainDrug misusePrior monthTreatment programPolice training to align law enforcement and HIV prevention: preliminary evidence from the field.
Beletsky L, Agrawal A, Moreau B, Kumar P, Weiss-Laxer N, Heimer R. Police training to align law enforcement and HIV prevention: preliminary evidence from the field. American Journal Of Public Health 2011, 101: 2012-5. PMID: 21940924, PMCID: PMC3222387, DOI: 10.2105/ajph.2011.300254.Peer-Reviewed Original ResearchConceptsLegal knowledgeLaw enforcementSyringe accessOccupational safety educationOccupational safety knowledgePolice trainingAccess lawsPolice professionalsNeedlestick injuriesPublic health goalsEnforcementIntervention tailoringRisk overestimationOccupational SafetyPublic healthHealth goalsLawHIV preventionDrug useAccess contentAccessInjuryBaseline dataPreliminary evidenceSignificant shiftPrevalence, characteristics, and predictors of police training initiatives by US SEPs: Building an evidence base for structural interventions
Beletsky L, Grau LE, White E, Bowman S, Heimer R. Prevalence, characteristics, and predictors of police training initiatives by US SEPs: Building an evidence base for structural interventions. Drug And Alcohol Dependence 2011, 119: 145-149. PMID: 21705159, PMCID: PMC3192926, DOI: 10.1016/j.drugalcdep.2011.05.034.Peer-Reviewed Original ResearchConceptsSyringe exchange programsInjection drug usersNeedle stick injuriesCommunity-based prevention initiativesPublic health benefitsStick injuriesHIV transmissionPublic health rationaleDrug usersMost program managersMultivariate analysisSyringe possessionPrevention initiativesEvidence baseHealth benefitsCommunity healthOccupational healthHealth rationaleMultivariate modelingPrevalenceStructural interventionsSEP operationsPredictorsHealthPrevious yearSubpopulations of Illicit Drug Users Reached by Targeted Street Outreach and Respondent-Driven Sampling Strategies: Implications for Research and Public Health Practice
Rudolph AE, Crawford ND, Latkin C, Heimer R, Benjamin EO, Jones KC, Fuller CM. Subpopulations of Illicit Drug Users Reached by Targeted Street Outreach and Respondent-Driven Sampling Strategies: Implications for Research and Public Health Practice. Annals Of Epidemiology 2011, 21: 280-289. PMID: 21376275, PMCID: PMC3062521, DOI: 10.1016/j.annepidem.2010.11.007.Peer-Reviewed Original ResearchConceptsRespondent-driven samplingPublic health practiceIllicit drug usersDrug usersStreet outreachHealth practicesDrug network characteristicsLog-binomial regressionNeedle exchange programsPublic health practitionersBaseline questionnaireHeroin usersDrug useHealth practitionersCocaine usersRecruitment wavesDifferent subgroupsRecruitment biasesRecruitment strategiesDescriptive statisticsNew York CityYork CityHeroinExchange programs
2010
Epidemiologic trends and geographic patterns of fatal opioid intoxications in Connecticut, USA: 1997–2007
Green TC, Grau LE, Carver HW, Kinzly M, Heimer R. Epidemiologic trends and geographic patterns of fatal opioid intoxications in Connecticut, USA: 1997–2007. Drug And Alcohol Dependence 2010, 115: 221-228. PMID: 21131140, PMCID: PMC3095753, DOI: 10.1016/j.drugalcdep.2010.11.007.Peer-Reviewed Original ResearchConceptsPrescription opioidsOpioid typeIntoxication deathsRisk factorsDrug intoxication deathsHeroin-related deathsOpioid-related deathsFatal opioid overdoseChief Medical ExaminerOpioid intoxicationOpioid deathsDrug poisoningInjury deathsEpidemiologic trendsOpioid overdoseOpioidsDeath locationPrevention effortsDeathMedical examinersRegression analysisSignificant increasePublic healthEpidemiologyHeroinComparing sexual risks and patterns of alcohol and drug use between injection drug users (IDUs) and non-IDUs who report sexual partnerships with IDUs in St. Petersburg, Russia
Abdala N, White E, Toussova OV, Krasnoselskikh TV, Verevochkin S, Kozlov AP, Heimer R. Comparing sexual risks and patterns of alcohol and drug use between injection drug users (IDUs) and non-IDUs who report sexual partnerships with IDUs in St. Petersburg, Russia. BMC Public Health 2010, 10: 676. PMID: 21054855, PMCID: PMC2988741, DOI: 10.1186/1471-2458-10-676.Peer-Reviewed Original ResearchConceptsInjection drug usersIDU sex partnersNon-IDUsRisky alcohol useSex partnersAlcohol useIDU populationSexual riskSexual transmissionUnprotected sexAlcohol Use Disorders Identification TestHIV prevention programsMultiple sexual partnersPatterns of alcoholSexual risk behaviorsSubstance use patternsDisorders Identification TestRisky sexual practicesHIV infectionMethamphetamine injectionAssessed associationsBackgroundTo dateCasual partnersGeneral populationDrug usersThe roles of law, client race and program visibility in shaping police interference with the operation of US syringe exchange programs
Beletsky L, Grau LE, White E, Bowman S, Heimer R. The roles of law, client race and program visibility in shaping police interference with the operation of US syringe exchange programs. Addiction 2010, 106: 357-365. PMID: 21054615, PMCID: PMC3088513, DOI: 10.1111/j.1360-0443.2010.03149.x.Peer-Reviewed Original ResearchThe Relative Role of Perceived Partner Risks in Promoting Condom Use in a Three-City Sample of High-Risk, Low-Income Women
Ober AJ, Iguchi MY, Weiss RE, Gorbach PM, Heimer R, Ouellet LJ, Shoptaw S, Anglin MD, Zule WA. The Relative Role of Perceived Partner Risks in Promoting Condom Use in a Three-City Sample of High-Risk, Low-Income Women. AIDS And Behavior 2010, 15: 1347-1358. PMID: 20976538, PMCID: PMC3180610, DOI: 10.1007/s10461-010-9840-7.Peer-Reviewed Original ResearchSurvival of Hepatitis C Virus in Syringes: Implication for Transmission among Injection Drug Users
Paintsil E, He H, Peters C, Lindenbach BD, Heimer R. Survival of Hepatitis C Virus in Syringes: Implication for Transmission among Injection Drug Users. The Journal Of Infectious Diseases 2010, 202: 984-990. PMID: 20726768, PMCID: PMC2932767, DOI: 10.1086/656212.Peer-Reviewed Original ResearchConceptsHepatitis C virusInjection drug usersDrug usersC virusHigh prevalenceInsulin syringesViable virusTuberculin syringesHCV infectivityResidual volumeReporter virusDay 1Prevention strategiesDay 7Microculture assayDay 63VirusLuciferase activitySyringesDegrees CPrevalenceVirus survivalSurvivalVirus decay ratesDays