2025
Allocative efficiency analysis of strategies to reduce overdose deaths among people with opioid use disorder and history of incarceration in Connecticut.
Scheidell JD, Frechette JM, Townsend TN, Zhou Q, Manandhar-Sasaki P, Fiellin DA, Heimer R, Puglisi LB, Charles DL, Su JI, Biegacki ET, Braithwaite RS. Allocative efficiency analysis of strategies to reduce overdose deaths among people with opioid use disorder and history of incarceration in Connecticut. BMC Public Health 2025, 25: 3209. PMID: 41029627, DOI: 10.1186/s12889-025-24432-2.Peer-Reviewed Original Research“Everybody’s Liking It”—Intentional Use of Xylazine in Fentanyl Among People Who Use Drugs
Hill K, Heimer R, Sue K. “Everybody’s Liking It”—Intentional Use of Xylazine in Fentanyl Among People Who Use Drugs. Substance Use & Misuse 2025, ahead-of-print: 1-8. PMID: 40847818, DOI: 10.1080/10826084.2025.2549499.Peer-Reviewed Original ResearchReceipt of addiction treatment after nonfatal opioid overdose and risk of subsequent overdose: A retrospective cohort study
Howell B, Black A, Lin H, Liberatore M, Greene C, D'Onofrio G, Heimer R, Grau L, Hawk K, Fiellin D, Becker W. Receipt of addiction treatment after nonfatal opioid overdose and risk of subsequent overdose: A retrospective cohort study. Drug And Alcohol Dependence 2025, 273: 112679. PMID: 40413965, PMCID: PMC12178112, DOI: 10.1016/j.drugalcdep.2025.112679.Peer-Reviewed Original ResearchConceptsAddiction treatment modalitiesAddiction treatmentInpatient addiction treatmentOpioid overdose survivorsOverdose survivorsOpioid agonist treatmentOpioid overdoseReceipt of methadoneOpioid withdrawalInpatient treatmentBenzodiazepine exposureNon-medicalAddictionAssociated with reduced riskNonfatal opioid overdoseAgonist treatmentNon-fatal opioid overdoseTreatment modalitiesAssociated with increased riskBenzodiazepinesIndividual level dataMethadoneRetrospective cohort studyOpioidBuprenorphineSpatial associations between alcohol detection in opioid overdose deaths and alcohol outlets
Viera A, Heimer R, Grau L. Spatial associations between alcohol detection in opioid overdose deaths and alcohol outlets. Drug And Alcohol Dependence 2025, 271: 112659. PMID: 40184870, PMCID: PMC12050193, DOI: 10.1016/j.drugalcdep.2025.112659.Peer-Reviewed Original ResearchConceptsOff-premise alcohol outletsNearest alcohol outletAlcohol outletsOpioid overdose deathsSpatial distribution of alcohol outletsSubstance use patternsDistribution of alcohol outletsDensity of alcohol outletsOverdose deathsDepressive effects of opioidsAlcohol outlet densityEffects of opioidsCensus tract levelAssociated with increased oddsOverdose riskCentral nervous systemOutlet densityTract levelCensus tractsDepressant effectCommunity investmentOpioidSocial vulnerabilityAlcoholNervous systemS112 Primary Care Buprenorphine Provision in the US South and Midwest: Prescribing Changes Post-Data Waiver Elimination
Osweiler B, Baied M, Narayanan N, Lynch Z, Backes K, Wang K, Humphries D, Heimer R, Marotta P. S112 Primary Care Buprenorphine Provision in the US South and Midwest: Prescribing Changes Post-Data Waiver Elimination. Drug And Alcohol Dependence 2025, 267: 111532. DOI: 10.1016/j.drugalcdep.2024.111532.Peer-Reviewed Original ResearchS89 The System Isn’t Broken; How do we fix it? The Need for Workplace Education About Harm Reduction
Narayanan N, Baied M, Humphries D, Wang K, Marotta P, Heimer R. S89 The System Isn’t Broken; How do we fix it? The Need for Workplace Education About Harm Reduction. Drug And Alcohol Dependence 2025, 267: 111509. DOI: 10.1016/j.drugalcdep.2024.111509.Peer-Reviewed Original ResearchRural providers’ attitudes toward integrating harm reduction strategies and PrEP prescribing into rural primary care settings in the US. Southeast and Midwest
Marotta P, Biaid M, Heimer R, Humphries D, Wang K, Narayanan N, Lynch Z, McKay V, Reno H, Winograd R, Goddard-Eckrich D, Filiatreau L, Stringer K, Backes K, Cavazos-Rehg P. Rural providers’ attitudes toward integrating harm reduction strategies and PrEP prescribing into rural primary care settings in the US. Southeast and Midwest. Addiction Science & Clinical Practice 2025, 20: 73. PMID: 40940646, PMCID: PMC12427098, DOI: 10.1186/s13722-025-00584-9.Peer-Reviewed Original ResearchMeSH KeywordsAdultAttitude of Health PersonnelBuprenorphineFemaleHarm ReductionHIV InfectionsHumansMaleMethadoneMiddle AgedMidwestern United StatesNarcotic AntagonistsOpiate Substitution TreatmentOpioid-Related DisordersPractice Patterns, Physicians'Pre-Exposure ProphylaxisPrimary Health CareRural Health ServicesSoutheastern United StatesUnited StatesConceptsPrimary health care providersRural primary care settingsPrimary care settingPrimary careProvider attitudesHarm reduction servicesHarm reduction strategiesOpioid use disorderPrEP prescribingCare providersCare settingsHealth centersPast-yearReduction servicesHarm reductionFederally Qualified Health CentersHarms of drug usePrimary care providersQualified health centersRural health clinicsSample of providersHealth care providersComprehensive harm reductionSouth and MidwestSyringe exchange
2024
A place-based spatial analysis of racial inequities in overdose in St. Louis County Missouri, United States
Marotta P, Leach B, Hutson W, Caplan J, Lohmann B, Hughes C, Banks D, Roll S, Chun Y, Jabbari J, Ancona R, Mueller K, Cooper B, Anasti T, Dell N, Winograd R, Heimer R. A place-based spatial analysis of racial inequities in overdose in St. Louis County Missouri, United States. International Journal Of Drug Policy 2024, 134: 104611. PMID: 39488868, PMCID: PMC12128610, DOI: 10.1016/j.drugpo.2024.104611.Peer-Reviewed Original ResearchConceptsRisk terrain modelingRelative risk valuesRelative risk scoreWhite decedentsHarm reduction strategiesHeightened overdose riskPolice departmentsBlack decedentsHousing AuthorityRacial inequalityOverdose riskRisk scoreSocial conditionsDecedentsOverdose dataForeclosureCounty Medical Examiner's OfficeMedical Examiner's OfficeProviders’ knowledge and perception of xylazine in the unregulated drug supply: a sequential explanatory mixed-methods study
Hill K, Minahan-Rowley R, Biegacki E, Heimer R, Sue K. Providers’ knowledge and perception of xylazine in the unregulated drug supply: a sequential explanatory mixed-methods study. Harm Reduction Journal 2024, 21: 148. PMID: 39148036, PMCID: PMC11328386, DOI: 10.1186/s12954-024-01052-4.Peer-Reviewed Original ResearchConceptsSequential explanatory mixed-methods studyExplanatory mixed-methods studyMixed-methods studyHealthcare providersHealthcare providers' experiencesHealthcare providers treating patientsSample of providersProviders treating patientsDrug supplyProvider experienceProvider knowledgeIn-depth interviewsImprove careSense of helplessnessConvenience sampleHealthcare educationThematic analysisInterview transcriptsQualitative phasePurposive samplingProvidersHealthcareOpioid supplyAbsence of literatureResultsSeventy-eightT50 Receipt of Prescribed Opioids and Benzodiazepines After Non-Fatal Overdose and Risk of Subsequent Overdose
Howell B, Black A, Lin H, Lauretta G, Heimer R, Hawk K, D'Onofrio G, Fiellin D, Becker W. T50 Receipt of Prescribed Opioids and Benzodiazepines After Non-Fatal Overdose and Risk of Subsequent Overdose. Drug And Alcohol Dependence 2024, 260: 110499. DOI: 10.1016/j.drugalcdep.2023.110499.Peer-Reviewed Original ResearchW48 The Development of a Conceptual Model to Assess Intersectional Stigma’s Role in Shaping Rural Primary Care Providers’ Decisions to Implement Harm Reduction, Buprenorphine, and HIV Prevention
Marotta P, Backes K, Baied M, Filiatreau L, Winograd R, Reno H, Wang K, Heimer R, McDannold C, Cavazos P. W48 The Development of a Conceptual Model to Assess Intersectional Stigma’s Role in Shaping Rural Primary Care Providers’ Decisions to Implement Harm Reduction, Buprenorphine, and HIV Prevention. Drug And Alcohol Dependence 2024, 260: 110666. DOI: 10.1016/j.drugalcdep.2023.110666.Peer-Reviewed Original ResearchUsing 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 determinationPrescription Opioid Dose Change Before Fatal Opioid-Detected Overdose.
Kazemitabar M, Howell B, Becker W, Lin H, Grau L, Heimer R, D'Onofrio G, Hawk K, Fiellin D, Black A. Prescription Opioid Dose Change Before Fatal Opioid-Detected Overdose. Journal Of Studies On Alcohol And Drugs 2024, 85: 815-819. PMID: 38775307, DOI: 10.15288/jsad.24-00026.Peer-Reviewed Original ResearchPrescribed opioidsOpioid dose changesRapid dose increaseNon-HispanicOverdose deathsToxicological resultsNon-prescription opioidsBlack non-HispanicMorphine equivalentsOpioid therapyWhite non-HispanicDose changesDaily doseMean ageDispensed opioidsPrescription opioidsPrescribing patternsOpioidDose increaseOpioid overdose crisisIncreasing dosesStudy investigated patternsEffect of timeEffects of ageSecondary analysisAccessibility 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 levelSevere acute respiratory coronavirus virus 2 (SARS-CoV-2) RNA and viable virus contamination of hospital emergency department surfaces and association with patient coronavirus disease 2019 (COVID-19) status and aerosol-generating procedures
Roberts S, Barbell E, Barber D, Dahlberg S, Heimer R, Jubanyik K, Parwani V, Pettigrew M, Tanner J, Ulrich A, Wade M, Wyllie A, Yolda-Carr D, Martinello R, Tanner W. Severe acute respiratory coronavirus virus 2 (SARS-CoV-2) RNA and viable virus contamination of hospital emergency department surfaces and association with patient coronavirus disease 2019 (COVID-19) status and aerosol-generating procedures. Infection Control And Hospital Epidemiology 2023, 45: 244-246. PMID: 37767709, PMCID: PMC10877528, DOI: 10.1017/ice.2023.183.Peer-Reviewed Original ResearchExperiences of stigma, mental health, and coping strategies in Lebanon among Lebanese and displaced Syrian men who have sex with men: A qualitative study
Abboud S, Seal D, Pachankis J, Khoshnood K, Khouri D, Fouad F, Heimer R. Experiences of stigma, mental health, and coping strategies in Lebanon among Lebanese and displaced Syrian men who have sex with men: A qualitative study. Social Science & Medicine 2023, 335: 116248. PMID: 37742387, DOI: 10.1016/j.socscimed.2023.116248.Peer-Reviewed Original ResearchMental healthAvailable mental health servicesMental health servicesSexual health risksMental health resourcesMental health risksHealth risksAdverse childhood experiencesSocial support interventionsQualitative studyExperiences of stigmaHealth servicesRecent exposureSupport interventionsLarger studyHealth resourcesMSMCommon stigmaSocial isolationMenHigh rateSexSyrian menChildhood experiencesHealthXylazine in the drug supply: Emerging threats and lessons learned in areas with high levels of adulteration
Quijano T, Crowell J, Eggert K, Clark K, Alexander M, Grau L, Heimer R. Xylazine in the drug supply: Emerging threats and lessons learned in areas with high levels of adulteration. International Journal Of Drug Policy 2023, 120: 104154. PMID: 37574646, DOI: 10.1016/j.drugpo.2023.104154.Peer-Reviewed Original ResearchHarm reduction service providersDrug supplySedative-analgesic drugsFatal opioid overdosesOpioid overdose fatalitiesPresence of fentanylMedical examiner dataIllicit drug supplyInjection of xylazineFentanyl test stripsPrevention needsOpioid usersAnalgesic drugsOpioid overdosesOverdose deathsOverdose fatalitiesXylazineHealth threatSurvey of peopleDrugsSignificant predictorsFentanylConvenience surveyTest stripsTwo-thirdsTechnical 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 Research
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