BACKGROUND:Fentanyl test strips (FTS) have become a critical harm reduction tool, allowing people who use drugs (PWUD) to detect fentanyl in their drug supply and make informed decisions about their drug use. While FTS distribution is increasingly common, there is limited understanding of distribution strategies used by community organizations, and the education and training provided around FTS use. Given the proliferation of fentanyl in the drug supply, and the diverse motivations of PWUD, research is needed to better understand FTS distribution and training practices. This study examines FTS distribution strategies, training approaches, and the facilitators and barriers faced by harm reduction organizations in Kentucky, Ohio, and New York. METHODS:We conducted a mixed-methods study as part of the Stay Safe Study, using a quantitative survey and qualitative interviews with organizations distributing FTS. Organizations included syringe service programs, mobile outreach units, recovery centers, and public health departments. Survey data were used to describe organizational characteristics and distribution practices, while interview data were coded and analyzed for themes related to distribution practices, training, and facilitators and barriers of FTS distribution. RESULTS:Twenty-eight organizations completed the organizational survey, and staff from 21 organizations participated in interviews. FTS distribution settings varied widely. Most organizations distributed between 100 and 500 FTS monthly, primarily on an "as needed" basis. Legalization of FTS was identified as a key facilitator, and innovative distribution methods included vending machines and mail distribution. Partnerships within the community expanded the reach and accessibility of FTS. Training approaches for both staff and PWUD varied substantially, and organizations faced barriers related to securing buy-in and the time required for training. CONCLUSIONS:This study highlights organizational practices related to FTS distribution and training. Participants viewed FTS as a gateway to providing broader harm reduction services, fostering trust and engagement with PWUD. To maximize the impact of FTS as an overdose prevention tool, it is important to address persistent barriers through tailored distribution and training strategies, sustainable funding, and scalable implementation models.

Xylazine is increasingly detected in overdose fatalities across the US. Xylazine test strips (XTS) are provided at no cost to people who use drugs (PWUD) in New York State (NYS) to encourage informed decision-making and safer drug-use behavior. XTS were only made available publicly in 2023, so there are likely discrepancies in XTS access and availability. This study aims to explore the differences in xylazine and XTS use across racial and ethnic groups. The Stay Safe Study (SSS) is a multi-state study examining drug-checking behaviors among PWUD over a 28-day observation period. Questions about XTS use were added to the parent study’s baseline survey of PWUD in NYS alone (n = 254). Logistic regression models were used to assess differences in xylazine and XTS use across racial and ethnic subgroups. Compared to non-Hispanic White (NHW) respondents, Black participants reported 63

OBJECTIVES:Xylazine test strips (XTS) allow for rapid identification of xylazine in drugs, yet little is known about those using XTS. Therefore, this study explores the characteristics of people who use drugs (PWUDs) who use XTS and examines risk reduction behaviors associated with XTS use. METHODS:This observational cohort study was conducted in New York between September and December 2023 as part of a larger study. Questions about XTS use were added to the parent study's baseline survey of PWUDs and were completed by 254 PWUDs. Sociodemographic characteristics compared XTS users to nonusers. Propensity score weighting using inverse probability of treatment weights was used to examine the association of ever-using XTS with risk reduction behaviors and the drug type used. RESULTS:Sixty-six participants (26%) had used XTS; 80% trusted the results, and 79% were confident in their ability to use XTS to detect xylazine. Those who had used XTS were more likely to have naloxone nearby (aOR=7.51, 95% CI: 2.26-24.95, P =0.001), use a test shot (aOR=2.43, 95% CI: 1.18-5.01, P =0.016), have someone check on them while using (aOR=2.52, 95% CI: 1.23-5.19, P =0.012), and watch someone use the same drugs (aOR=2.35, 95% CI: 1.19-4.65, P =0.014). XTS use was associated with using opioids (aOR=3.68, 95% CI: 1.38-9.81, P =0.009) and injecting drugs (aOR=4.32, 95% CI: 1.91-9.77, P <0.001). CONCLUSIONS:Our study demonstrates that XTS use appears to be associated with engaging in risk reduction behaviors, suggesting XTS can be a useful harm reduction tool. More research is needed to assess whether PWUDs change their drug consumption behaviors based on XTS results.

BACKGROUND:The Stay Safe Study, conducted between May and December 2023 in the United States, investigated the association between fentanyl test strip (FTS) use and risk reduction behaviors. This paper examines the association between self-reported FTS results and change in drug use behaviors. METHODS:We solicited self-reported drug and FTS use among people who use drugs (PWUD), with a baseline and four weekly surveys over a 28-day observation period in three states (Kentucky, New York and Ohio). For each day participants reported drug use, they were asked types of drugs used, use of FTS, FTS results, and 12 drug use behavior changes because of the result. A generalized estimating equation approach was used to model associations between FTS results and each outcome. RESULTS:These analyses included 541 PWUD who used FTS at least once in the observation period. Positive FTS results were associated with participants taking turns, having naloxone nearby, and using less drugs. There was a four-fold reduction in the amount of drugs used following a positive FTS result (odds ratio (OR)=4.37; 95 % CI, 3.45-5.55). This was modified by self-reported types of drugs tested, with a 20-fold reduction when testing illicit benzodiazepines (OR=19.92; 95 % CI, 8.6-46.27), a 10-fold reduction when testing illicit stimulants (OR=10.04; 95 % CI, 6.49-15.53), and 2-fold reduction in drugs used when testing illicit opioids or other drugs tested (OR=2.11; 95 % CI, 1.14-3.92). CONCLUSIONS:These findings suggest that FTS assist PWUD to immediately reduce their risks by changing drug use behaviors, including reducing the amount of drug used.

Importance:Illegal fentanyl is driving overdose mortality, and fentanyl test strips (FTS) can be used to test drugs for fentanyl at the point of consumption. Evidence on whether FTS use is associated with overdose risk reduction behaviors is encouraging, but largely limited to smaller, single-site studies. Objective:To determine whether self-reported baseline FTS use among people who use drugs (PWUD) was associated with overdose risk reduction behaviors and nonfatal overdose over a 28-day follow-up. Design, Setting, and Participants:Multisite, observational cohort study of PWUD conducted from May to December 2023 as an ancillary study of the HEALing Communities Study, which consists of fixed and mobile direct service provision sites in 14 community partner organizations distributing FTS. Participants lived in Kentucky, New York, or Ohio and reported using heroin, fentanyl, cocaine, methamphetamine, or nonprescribed opioids, benzodiazepines, or stimulants within 30 days before baseline. Participants were followed up for a maximum of 37 days. Exposure:Baseline FTS use. Main Outcome and Measures:The primary outcome was a composite score measuring the self-reported number and frequency of using 8 overdose risk reduction behaviors. Secondary outcomes included multiple measures (eg, self-reported nonfatal overdose). Results:The study included 732 participants (median [IQR] age, 41 [34.0-48.0] years; 369 [50.4%] male; 64 [8.9%] Black or African American, 587 [81.3%] White, and 71 [9.8%] other races); 414 reported baseline FTS use and 318 did not. Compared with nonusers, a higher percentage of baseline FTS users were from Ohio and White, while a lower percentage were from New York and Hispanic and/or Black. In adjusted analyses, PWUD who used FTS had a mean daily composite score for overdose risk reduction behaviors that was 0.86 (95% CI, 0.34-1.38) units higher across follow-up compared with nonusers (score for FTS users, 7.37; nonusers, 6.51). There was no difference in self-reported nonfatal overdoses between the 2 groups (mean daily risk for FTS users, 0.02; nonusers, 0.02; risk ratio, 1.20; 95% CI, 0.70-2.06). Conclusions and Relevance:In this cohort study, baseline FTS use was associated with greater engagement in overdose risk reduction behaviors during follow-up, but not with the risk of nonfatal overdose during follow-up, suggesting PWUD who use FTS may also engage in a broader set of harm reduction strategies.

BACKGROUND Evidence-based practices for reducing opioid-related overdose deaths include overdose education and naloxone distribution, the use of medications for the treatment of opioid use disorder, and prescription opioid safety. Data are needed on the effectiveness of a community-engaged intervention to reduce opioid-related overdose deaths through enhanced uptake of these practices. METHODS In this community-level, cluster-randomized trial, we randomly assigned 67 communities in Kentucky, Massachusetts, New York, and Ohio to receive the intervention (34 communities) or a wait-list control (33 communities), stratified according to state. The trial was conducted within the context of both the coronavirus disease 2019 (Covid-19) pandemic and a national surge in the number of fentanyl-related overdose deaths. The trial groups were balanced within states according to urban or rural classification, previous overdose rate, and community population. The primary outcome was the number of opioid-related overdose deaths among community adults. RESULTS During the comparison period from July 2021 through June 2022, the population-averaged rates of opioid-related overdose deaths were similar in the intervention group and the control group (47.2 deaths per 100,000 population vs. 51.7 per 100,000 population), for an adjusted rate ratio of 0.91 (95% confidence interval, 0.76 to 1.09; P=0.30). The effect of the intervention on the rate of opioid-related overdose deaths did not differ appreciably according to state, urban or rural category, age, sex, or race or ethnic group. Intervention communities implemented 615 evidence-based practice strategies from the 806 strategies selected by communities (254 involving overdose education and naloxone distribution, 256 involving the use of medications for opioid use disorder, and 105 involving prescription opioid safety). Of these evidence-based practice strategies, only 235 (38%) had been initiated by the start of the comparison year. CONCLUSIONS In this 12-month multimodal intervention trial involving community coalitions in the deployment of evidence-based practices to reduce opioid overdose deaths, death rates were similar in the intervention group and the control group in the context of the Covid-19 pandemic and the fentanyl-related overdose epidemic.

Objective: Timely data on drug overdose deaths can help identify community needs, evaluate the effectiveness of interventions, and allocate resources. We identified variations in death investigation and reporting systems within and between states that affect the timeliness and accuracy of death certificate information. Methods: The HEALing Communities Study (HCS) is a community-engaged, data-driven approach to combating the opioid crisis in 67 communities in 4 states: Kentucky, Massachusetts, New York, and Ohio. HCS conducted a survey of coroners and medical examiners to understand variability in drug overdose death data. We compared survey results in Massachusetts, New York, and Ohio with national data to investigate the completeness of provisional death counts by type of death investigation system. Results: Communities in each HCS state had different ways of collecting and reporting mortality data. Completion of death certificates for drug overdoses ranged from <2 weeks in 23% (7 of 31) of those surveyed to more than 3 months in 10% (3 of 31) of those surveyed. Variabilities in the timeliness of reporting drug overdose deaths were not associated with type of coroner or medical examiner office in each state, urban versus rural setting, or specificity of drug information on the death certificate. Conclusion: Having specific drug information on the death certificate may increase death certificate quality, comparability, and accuracy. We recommend the following: (1) all coroners and medical examiners should be trained on conducting death investigations, interpreting toxicology reports, and completing death certificates; (2) 1 office in each state should oversee all coroners and medical examiners to increase data consistency; and (3) communities should identify and address barriers to timely death certification.

Introduction Individuals with opioid use disorder (OUD) transitioning from jails or prisons to the community are at high risk of overdose-related death shortly after release. Buprenorphine, methadone, and extended-release naltrexone are FDA-approved medications for opioid use disorder (MOUD) to reduce overdose risk and increase treatment engagement. Despite the evidence, many correctional facilities in the United States do not provide MOUD to their incarcerated population. Albany County Jail and Rehabilitative Services Center (ACCRSC) is a jail in New York State that provides comprehensive MOUD and overdose prevention services to all incarcerated individuals with OUD. Methods MOUD program participants' data was collected during custody and after release to determine whether the program's primary goals of preventing overdose-related mortality and MOUD continuation after release were met. Other quality-of-life metrics were used for program improvements, such as program participants' physical and mental well-being, postrelease housing, employment, access to mental health services, and re-incarceration. Results This study included 375 unique individuals who received MOUD treatment at the jail between January 19, 2019, and the end of December 2020, with 56.2 % continuing their treatment and 43.7 % initiating MOUD during custody. Among those who initiated MOUD at ACCRSC, 93.3 % were enrolled in buprenorphine. We identified eight program participant deaths after release within a year after incarceration. The average time between release and death was 233 days, with the shortest time between release and death being 107 days. We found that over half (53.6 %) of program participants using buprenorphine picked up their prescriptions after exiting ACCRSC. Among those who did not, nearly 16 % were unable to do so because they were transferred to another jail or prison that did not provide MOUD care. Overall, nearly 80 % of program participants who were transferred to another correctional facility could not continue their medication. Conclusions MOUD in correctional settings appears to reduce overdose deaths immediately after release. Administering buprenorphine and other types of MOUD in a jail setting has shown relatively high retention for people to fill their first prescription of buprenorphine outside the jail. To ensure high MOUD retention among incarcerated populations, all correctional facilities must provide MOUD care.

Opioid-related overdose deaths have increased since 2010 in the U.S., but information on trends in opioid use disorder (OUD) prevalence is limited due to unreliable data. Multiplier methods are a classical epidemiological technique to estimate prevalence when direct estimation is infeasible or unreliable. We used two different multiplier approaches to estimate OUD prevalence from 2010 to 2019. First, we estimated OUD in National Survey on Drug Use and Health (NSDUH), and based on existing capture-recapture studies, multiplied prevalence by 4.5x. Second, we estimated the probability of drug poisoning death among people with OUD (Meta -analysis indicates 0.52/100,000), and divided the number of drug poisoning deaths in the US by this probability. Estimates were weighted to account for increase in drug-related mortality in recent years due to fentanyl. Estimated OUD prevalence was lowest when estimated in NSDUH with no multiplier, and highest when estimated from vital statistics data without adjustment. Consistent findings emerged with two methods: NSDUH data with multiplier correction, and vital statistics data with multiplier and adjustment. From these two methods, OUD prevalence increased from 2010 to 2014; then stabilized and slightly declined annually (survey data with multiplier, highest prevalence of 4.0% in 2015; death data with a multiplier and correction, highest prevalence of 2.35% in 2016). The number of US adolescent and adult individuals with OUD in 2019 was estimated between 6.7-7.6 million. When multipliers and corrections are used, OUD may have stabilized or slightly declined after 2015. Nevertheless, it remains highly prevalent, affecting 6-7 million US adolescents and adults.

The extent of methylmercury exposures among adults in New York State (NYS) has not been well characterized. Over the past few years, the NYS Heavy Metals Registry (HMR) has seen an increase in both blood mercury tests being reported, and nonoccupational exposures to mercury, which appear primarily due to fish consumption. This study will, (1) Characterize the adults who are tested for blood mercury in NYS; (2) Examine the circumstances for blood mercury testing; and (3) Characterize this population in terms of exposure history, specifically those individuals who are non-occupationally exposed through a diet of seafood consumption in reference to blood mercury levels. Data available from HMR laboratory results, including basic demographics and test results, were combined with data from telephone interviews. The interview contains information on the reasons for testing, possible sources of exposure, and the individual's work and home environment. Approximately 99 % of adults reported to the HMR, with identifiable exposures to mercury, had non-occupational exposures resulting from seafood consumption. Common types of fish consumed include salmon, tuna, and swordfish, with 90 % of adults eating seafood a few times or more per week. Information will be provided on the reasons for being tested and the range of blood mercury levels in relation to their seafood consumption. NYS residents who frequently eat fish should be aware of what types of fish contain mercury and avoid or reduce consumption of fish with high mercury levels.

While all states have regulations requiring reporting of diseases from health-care professionals and facilities, underreporting is substantial. To improve reporting to the New York State (NYS) Occupational Lung Disease Registry (OLDR), the NYS Department of Health's Bureau of Occupational Health initiated a multimedia campaign to increase case ascertainment and establish communication channels and partnerships for conducting prevention. The out-reach campaign was successful in raising physician awareness about the OLDR, familiarizing physicians with reporting forms and procedures, and increasing physician reporting. It also raised awareness of the contribution of occupational factors to respiratory illness and other conditions. However, while our evaluation indicated it is possible to affect short-term outcomes, such as knowledge, attitudes, and behavior among health-care providers, the campaign was not as successful in promoting sustained reporting.

Previous research has focused on highly elevated blood lead (PbB). This study examined reasons for testing and potential sources of exposure among women with PbBs less than 0.72 μmol/l (15 μg/dl). A questionnaire was mailed to 18- to 49-year-old women in upstate New York, USA, who were PbB tested in 2007. The most common testing reason was pregnancy among 125 women who returned the questionnaire. Among women tested for PbB during pregnancy, doctors ordered approximately 80% of tests regardless of lead level. Few women with PbBs less than 0.24 μmol/l (5 μg/dl) reported a potential source of lead exposure. However, among women with PbBs of 0.24–0.71 μmol/L (5–14.9 μg/dl), 29.2% had a job and 21.2% had a hobby with potential lead exposure. There are systematic differences in reasons for testing and exposure sources among women with PbBs less than 0.72 μmol/l and these differences have implications for screening.

Objective. The objective of this paper is to determine the percent of adults with asthma attributable to work and describe characteristics of the work-related asthma population in New York State. Sociodemographic and control characteristics of those with and without work-related asthma are compared. Methods. Data from three population-based surveys and one case-based surveillance system were analyzed. Work-relatedness of asthma was determined by self-report for the population-based surveys and by physician report for the case-based system. Self-reported sociodemographic and control characteristics were analyzed for the population-based surveys by work-relatedness. Results. The percent of work-relatedness among adults with current asthma in New York State ranged from 10.6% to 44.5%. Significantly more adults with work-related asthma had poorly controlled asthma than those without work-related asthma. More adults with work-related asthma also tended to be employed in the manufacturing, educational services, and public administration industries than the general population. The most frequently reported exposure was dust. Conclusions. Adults with work-related asthma have decreased control and adverse socioeconomic impacts compared to those with asthma that is not work-related. Increased recognition and physician reporting is necessary to further prevent the impact of work-related exposures.

Objectives. Laboratories that test New York State (NYS) employees and adult residents for lead exposure are required to report blood lead test results to the NYS Department of Healths Heavy Metals Registry. This registry is used to monitor exposures and to identify new high-risk occupational and nonoccupational activities. Methods. We used interviews conducted with people having blood lead levels of ≥25 micrograms/deciliter (μg/dL) reported to the Heavy Metals Registry to determine the primary source of lead exposure. We reviewed this information, together with demographic information, for the years 1994 through 2006. Results. While overall there has been an increase in the number of tests being conducted on NYS residents since 1994, the vast majority of the increase is among those with the lowest blood lead levels (<10 μg/dL). Conversely, there has been a decline in the number of adults tested with blood lead levels of ≥25 μg/dL in NYS due primarily to occupational exposures. However, nonoccupational exposures do represent a relatively large percentage of the individuals with severely elevated blood lead levels (≥60 μg/dL). Conclusions. Although a surveillance system based on blood lead levels cannot identify the true magnitude of adult lead poisoning, the NYS Heavy Metals Registry has proven to be an important tool for identifying situations in which adult lead poisoning is occurring, and assists in guiding lead poisoning prevention among adults.

BackgroundLimited epidemiologic studies have examined the association between maternal low-level lead exposure [blood lead (PbB) < 10 μg/dL] and fetal growth.ObjectiveWe examined whether maternal low-level lead exposure is associated with decreased fetal growth.MethodsWe linked New York State Heavy Metals Registry records of women who had PbB measurements with birth certificates to identify 43,288 mother–infant pairs in upstate New York in a retrospective cohort study from 2003 through 2005. We used multiple linear regression with fractional polynomials and logistic regression to relate birth weight, preterm delivery, and small for gestational age to PbB levels, adjusting for potential confounders. We used a closed-test procedure to identify the best fractional polynomials for PbB among 44 combinations.ResultsWe found a statistically significant association between PbB (square root transformed) and birth weight. Relative to 0 μg/dL, PbBs of 5 and 10 μg/dL were associated with an average of 61-g and 87-g decrease in birth weight, respectively. The adjusted odds ratio for PbBs between 3.1 and 9.9 μg/dL (highest quartile) was 1.04 [95% confidence interval (CI), 0.89–1.22] for preterm delivery and 1.07 (95% CI, 0.93–1.23) for small for gestational age, relative to PbBs ≤ 1 μg/dL (lowest quartile). No clear dose–response trends were evident when all of the quartiles were assessed.ConclusionsLow-level PbB was associated with a small risk of decreased birth weight with a supralinear dose–response relationship, but was not related to preterm birth or small for gestational age. The results have important implications regarding maternal PbB.

The New York State Heavy Metals Registry receives reports on all New Yorkers tested for lead. The Registry was reviewed for information on individuals who had lead exposure from target shooting. Overall, 598 individuals have been reported with exposures from target shooting. Over one-half had nonoccupational exposures. These individuals were reported more frequently with elevated blood lead levels (over 40 μg/dL) than those with occupational exposures. Hobby target shooters are at significant risk of having elevated blood lead levels. Because of the potential for serious lead exposure as a result of target shooting, efforts should be made to inform target shooters of the health risks and methods that can reduce exposure to themselves, other range users, and their families.

Objective: The objective of this study was to characterize the work-related asthma population seen by the New York State Occupational Health Clinic Network (OHCN) to determine which industries, occupations, and causal agents are associated with work-related asthma in New York State (NYS). Methods: The OHCN patient database was analyzed to identify those patients with a diagnosis of work-related asthma and medical charts were then abstracted for data on demographics, clinical history, disease severity, industry, occupation, and putative agent. Results: The OHCN patients with work-related asthma were most commonly employed in the service and manufacturing industries. Common occupations included teachers, farm operators/managers, and construction trades. The most frequently reported putative agents associated with work-related asthma were dust, indoor air, mold, and solvents. Conclusions: Our findings suggest the potential importance of prevention of workplace exposure in reducing adult asthma in NYS.

OBJECTIVE:Despite the existence of mandatory reporting laws, the underreporting of disease conditions to public health authorities is widespread. This article describes an evaluation of the effects of using different appeals to promote complete and timely reporting to the New York State Occupational Lung Disease Registry (NYS OLDR).METHODS:Three-hundred sixty-eight physicians who had not reported patients were randomly assigned to receive correspondence emphasizing either the legal obligation to report, the public health benefits of reporting, or both. Chi-square tests were used to determine if the proportion of physicians who subsequently reported patients differed by message group. Chi-square tests and the Kruskall Wallis rank sum test were used to test for differences in the completeness and timeliness of reports received from physicians in the three message groups.RESULTS:Physicians receiving correspondence describing the legal obligation to report were more likely to report patients than those receiving only the benefit message, while those receiving correspondence describing the public health benefits of reporting submitted more complete reports than those receiving only the obligation message.CONCLUSIONS:To maximize physician reporting, it is important for public health agencies to emphasize both the legal and public health basis for reporting conditions in correspondence to physicians.

The New York Fatality Assessment and Control Evaluation (FACE) program is designed to identify and study fatal occupational injuries in New York State. The New York FACE program is supported by the National Institute for Occupational Safety and Health (NIOSH) and administered by the New York State Department of Health (NYS DOH) in cooperation with Cornell University. New York FACE investigators evaluate information from multiple sources, conduct objective on-site investigations, and then summarize their findings in narrative reports that include recommendations for preventing similar events in the future. These recommendations are distributed to employers, workers, and other organizations as an educational tool for promoting workplace safety. The following case study involved a 53-year-old dairy farm owner who was fatally injured while transferring manure from an underground storage pit to a manure lagoon. At the time of the incident, the farmer was utilizing a manure pump that was connected to a tractor via a power take-off (PTO) shaft. The farmer reached across the unshielded PTO shaft in order to operate a hand crank that adjusted the manure pump chute. As he did this, his clothing became entangled in the PTO shaft, wrapping the farmer's body around the shaft. New York FACE investigators concluded that to help prevent similar incidents from occurring in the future: PTO-powered equipment should not be operated unless the PTO shield is in place and in good condition; Power to equipment should be turned off prior to making mechanical adjustments; Manure handling systems should be designed to facilitate operator safety; Farm workers should be healthy and well rested prior to performing hazardous activities and; Dairy farm workers should be trained in manure handling safety and knowledgeable about other manure hazards.

The purpose of this study was to examine the circumstances under which women receive blood lead tests in New York State and to characterize the sources of lead exposure among women of childbearing age with moderate blood lead levels. Telephone interviews were conducted with 135 women between the ages of 18 and 45, with blood lead levels from 10 through 25 μg/dl, were used to collect information on the reason for their blood lead test and possible sources of lead exposure. It was found that the two most common reasons to be tested for blood lead were workplace screening (47%) and pregnancy (27%). Occupational exposure was the primary source of lead exposure in this population (46%). Another common source of lead exposure was home renovation (24%). A significant proportion (31%) of women with blood lead levels from 10 through 25 μg/dl had no known current source of lead exposure. Based on New York's sample, there are a significant number of women of reproductive age with potentially fetotoxic blood lead levels.