Alex S Bennett

New York University School of Global Public Health · Social and Behavioral Sciences

Background People who use drugs are at elevated sexual and reproductive health risk but experience barriers to services. Syringe services programs (SSP) are an important venue to provide integrated health services. Few studies have examined SSP use within intersecting gender, racial, and ethnic groups, including by injection drug use (IDU), and dif...

Background: This descriptive study examined suspected xylazine co-involvement in law enforcement-recorded fentanyl overdoses in Pennsylvania (excluding Philadelphia), focusing on other drug involvement, naloxone administration, and survival. Methods: We examined data from 10,626 suspected fentanyl-involved overdoses (95 reportedly co-involving xyla...

Background: Innovative analytic approaches to drug studies are needed to understand better the co-use of opioids with non-opioids among people using illicit drugs. One approach is the Bayesian kernel machine regression (BKMR), widely applied in environmental epidemiology to study exposure mixtures but has received far less attention in substance us...

Background Naloxone is critical for reversing opioid-related overdoses. However, there is a dearth of research examining how naloxone possession and carriage are impacted by time-varying individual and social determinants, and if this differed during the height of the COVID-related mitigation measures (e.g., shutdowns). Methods We utilized weekly...

Background Overdose deaths continue to reach new records in New York City and nationwide, largely driven by adulterants such as fentanyl and xylazine in the illicit drug supply. Unknowingly consuming adulterated substances dramatically increases risks of overdose and other health problems, especially when individuals consume multiple adulterants an...

Objective: This commentary seeks to evaluate existing knowledge about the relationship between brain injury (BI) and overdose (OD), to unify distant bodies of literature, and to enhance prevention and treatment for opioid OD among individuals with BI. Background: There is a hidden epidemic of undiagnosed BI in the United States. Due to lack of s...

BACKGROUND Overdose deaths continue to reach new records in New York City and nationwide, largely driven by adulterants such as fentanyl and xylazine in the illicit drug supply. Unknowingly consuming adulterated substances dramatically increases risks of overdose and other health problems, especially when individuals consume multiple adulterants an...

Background: People who use drugs (PWUD) often have elevated sexually transmitted infection (STI) risk and unmet healthcare needs. Self-directed STI specimen collection (i.e., individuals collect the specimen and mail to the laboratory) may be valuable in addressing STI testing barriers among PWUD. Methods: Within a cohort study among PWUD in New Yo...

Background Opioid withdrawal is a regular occurrence among many people who use illicit opioids (PWUIO) that has also been shown to increase their willingness to engage in risk-involved behavior. The proliferation of fentanyl in the illicit opioid market may have amplified this relationship, potentially putting PWUIO at greater risk of negative heal...

Background: Drug overdose deaths continue to rise, and considerable racial inequities have emerged. Overdose Good Samaritan laws (GSLs) are intended to encourage overdose witnesses to seek emergency assistance. However, evidence of their effectiveness is mixed, and little is known regarding racial disparities in their implementation. This study ex...

This analysis identifies factors associated with overdose risk behaviors and non-fatal overdose among a sample of 577 adult-age people who use illicit opioids and live in NYC. Survey data--which included outcome measures assessing (1) past 30-day non-fatal overdose and past 30-day overdose-related risk behaviors and (2) predictors representing pote...

Background: Drug overdose mortality is rising precipitously among Black people who use drugs. In NYC, the overdose mortality rate is now highest in Black (38.2 per 100,000) followed by the Latinx (33.6 per 100,000) and white (32.7 per 100,000) residents. Improved understanding of access to harm reduction including naloxone across racial/ethnic gro...

Background Hepatitis C virus (HCV) infection has increased among persons who inject drugs (PWID) in the United States with disproportionate burden in rural areas. We use the Risk Environment framework to explore potential economic, physical, social, and political determinants of hepatitis C in rural southern Illinois. Methods Nineteen in-depth sem...

Background: Overdose is a leading cause of morbidity and mortality among people who inject drugs. Illicitly manufactured fentanyl is now a major driver of opioid overdose deaths. Methods: Semi-structured interviews were conducted with 23 participants (19 persons who inject drugs and 4 service providers) from rural southern Illinois. Data were an...

Technology-based behavioral health interventions offer potentially limitless opportunities to localize content and target specific populations. However, this ability to customize requires developers to make a wide range of decisions not only about who should appear on screen, but how each message should be refined to most effectively reach a partic...

Youth between the ages of 13 and 24 account for over 20% of new HIV diagnoses in the United States but are the least likely age group to be HIV tested in healthcare settings including the emergency department. This is in part due to the fact that almost 50% of youth decline testing when offered. We elucidated youth patients' perspectives on barrier...

U.S. military veterans have been heavily impacted by the opioid overdose crisis, with drug overdose mortality rates increasing by 53% from 2010–2019. Risk for overdose among veterans is complex and influenced by ongoing interaction among physiological/biological, psychological, and socio-structural factors. A thorough understanding of opioid-relate...

Background: Little is known regarding relationships among parenting, engagement in harm reduction services, and overdose risk among people who use illicit opioids (PWUIO), and whether associations differ by gender. Methods: Using baseline data from an ongoing study among PWUIO in New York City (n=575), we measured childcare factors (i.e., residing...

Background: Despite increased availability of take-home naloxone, many people who use opioids do so in unprotected contexts, with no other person who might administer naloxone present, increasing the likelihood that an overdose will result in death. Thus, there is a social nature to being "protected" from overdose mortality, which highlights the i...

HIV testing rates among US youth aged 13–24 years are sub-optimal, with high rates of missed testing opportunities in emergency departments (EDs). We assessed barriers to routine HIV testing of youth in urban ED settings from the perspective of healthcare providers. Ten physicians and nurses were recruited from the pediatric and adult EDs at a high...

Background : Concurrent opioid-related overdose and COVID-19 crises in the U.S. have imposed unprecedented challenges on people who use illicit opioids. Methods : Using the experiences of 324 people who use illicit opioids between April 2020 and March 2021, we examine four domains of health and well-being potentially impacted by COVID-19: drug ris...

Background: People who inject drugs (PWID) are disproportionately impacted by SARS-CoV-2 and COVID-19, yet frequently do not accept vaccinations against SARS-CoV-2 when offered. Objective: To explore why PWID decline free vaccinations against SARS-CoV-2, and how barriers to vaccination can potentially be addressed. Methods: We conducted semi-s...

BACKGROUND People who inject drugs are disproportionately impacted by SARS-CoV-2 and COVID-19, yet they do not frequently accept vaccination against SARS-CoV-2 when offered. OBJECTIVE This study aimed to explore why people who inject drugs decline free vaccines against SARS-CoV-2 and how barriers to vaccination can potentially be addressed. METHO...

Background Despite increased availability of take-home naloxone, many people who use opioids do so in unprotected contexts, with no other person who might administer naloxone present, increasing the likelihood that an overdose will result in death. Thus, there is a social nature to being “protected” from overdose mortality, which highlights the imp...

Objective To examine the factor structure of a revised and expanded opioid overdose risk behavior scale and assess its associations with known overdose indicators and other clinical constructs. Background Opioid-related overdose remains high in the U.S. We lack strong instrumentation for assessing behavioral risk factors. We revised and expanded t...

Over the past 25 years, naloxone has emerged as a critical lifesaving overdose antidote. Public health advocates and community activists established early methods for naloxone distribution to people who inject drugs, but a legacy of stigmatization and opposition to universal naloxone access continues to limit the drug's full potential to reduce opi...

Background: Many people use opioids and are at risk of overdose. Naloxone is an opioid antagonist used to counter the effects of opioid overdose. There is an increased availability of naloxone in New York City; however, many who use opioids decline no-cost naloxone even when offered. Others may have the medication but opt not to carry it and report...

Background Technology can enable syringe service programs (SSPs) and other community-based organizations (CBOs) operating under a harm reduction framework to work with an increased number of clients and can also enable organizations to offer services more effectively (e.g., offering HIV testing in ways participants may be more likely to accept). In...

Rates of undiagnosed youth human immunodeficiency virus (HIV) remain problematically high across the United States and internationally. In addition, youth HIV test rates remain consistently low, and youth with HIV remain undiagnosed for longer periods of time as compared with older populations. Youth HIV remains especially persistent among African...

Background: U.S. military veterans face many biopsychosocial (BPS) challenges post-service that may elevate risk for opioid-related overdose including physical pain, mental health concerns and social stressors. Some veterans use opioids to manage pain and cope with social readjustment. This study assessed associations between BPS factors and recen...

Background & Aims Numerous states in the U.S. are working to stem opioid‐involved overdose (OD) by engaging OD survivors before discharge from emergency departments (EDs). This analysis examines interactions between survivors and medical care providers that may influence opioid risk behaviors post‐OD. Design Qualitative stakeholder analysis involv...

Posttraumatic stress disorder (PTSD) stands as a form of psychopathology that straddles moral and psychiatric domains. Grounded in discrete instances of trauma, PTSD represents an etiological outlier in an era of increased attention to the genetics of mental illness and a prime location for social constructivist analyses of mental illness. This exa...

Background: Approximately 100 supervised injection facilities (SIFs) operate in 66 cities around the world to reduce overdose deaths, the spread of disease and public disorder, though none legally exist in the United States. Public bathrooms are among the most common public places for injection reported by people who inject drugs in New York City...

Background: The problem of injection drug use in public bathrooms has been documented from the perspectives of people who inject drugs and service industry employees (SIEs). Previous studies suggest that SIEs are unaware of how to respond to opioid overdoses, yet there are no behavioral interventions designed for SIEs to address their specific nee...

Background: Illicitly manufactured fentanyl (IMF) prevalence has increased. However, there is uncertainty about naloxone dose(s) used by nonmedical bystanders to reverse opioid overdoses in the context of increasing IMF. Methods: We used community naloxone distribution program data about naloxone doses and fatal opioid overdoses from the Allegheny...

Distribution of the opioid overdose reversal drug naloxone has been central to efforts to combat the ongoing opioid epidemic in the United States. This report presents data from Prevention Point Pittsburgh (PPP), a public health advocacy and direct service organization that has operated an overdose prevention program (OPP) with naloxone distributio...

The United States faces dramatically increasing rates of opioid overdose deaths, as well as persistent ongoing problems of undiagnosed HIV and HCV infection. These problems commonly occur together in substance using populations that have limited, if any, access to primary care and other routine health services. To collectively address all three iss...

Emergency departments (EDs) frequently serve people who have limited, if any, additional interactions with health care, yet many ED patients are not offered HIV testing, and those who are frequently decline. ED staff (n = 13) at a high volume urban ED (technicians, nurses, physicians, and administrators) were interviewed to elicit their perspective...

This study examines the temporal relationship between prescription opioid (PO) and heroin use among veterans in New York City. Drawing on survey data from a convenience sample of 214 OEF/OIF/OND-era opioid-using military veterans, analyses demonstrate substantial cohort-level variation. Most notably, heroin use prior to PO initiation and prior to m...

Background: Mirroring nationwide trends in a broad range of U.S. populations, an alarming number of Afghanistan/Iraq-era U.S. Military veterans have experienced opioid-related overdoses. A growing body of research has examined the proximal behaviors that can precipitate an overdose; considerably less is known about more distal physiological, psych...

Objective To identify meaningful classes of opioid-using military veterans in terms of self-reported opioid overdose risk behaviors. Method The study recruited a sample of 218 military veterans in the NYC area who were discharged from active duty service after September 11, 2001 and reported past-month opioid use. Survey data including measures of...

Rising rates of overdose mortality underscore the importance of understanding and preventing overdose. We developed a 7-item scale for the assessment of non-fatal opioid-related overdose experiences, adding items on others’ perceptions of whether the participant had overdosed and whether an intervention was attempted to frequently used criteria. We...

Background: Drug overdose has emerged as the leading cause of injury-related death in the U.S., driven by prescription opioid (PO) misuse, polysubstance use and use of heroin. To better understand opioid-related overdose risks that may change over time and across populations there is a need for a more comprehensive assessment of related risk behav...

The following report from the field focuses on the authors' collective efforts to operate an ad hoc safer injection facility (SIF) out of portapotties (portable toilets) in an area of the South Bronx that has consistently experienced some of the highest overdose morbidity and mortality rates in New York City over the past decade (New York City Depa...

The current paper reports on a study examining the use of a tablet-based multimedia intervention to increase HIV test rates among patients in a New York City hospital Emergency Department (ED) serving the Harlem area. The findings from this qualitative analysis of 40 ED patient interviews indicates how tablet-based multimedia can be expanded and ad...

People who inject drugs (PWID) have experienced the second highest number of HIV infections and HIV-related deaths of any risk group in the U.S. after men-who-have-sex-with-men (MSM), and they also suffer from high prevalence of Hepatitis C, other infectious diseases, and chronic health conditions. PWID in the US are currently most affected by 3 ov...

Observers describe today’s “epidemic” of pharmaceutical drug abuse as a recent phenomenon, but we argue that it is only the most recent of three waves stretching back more than a century. During each wave, policies have followed a similar pattern: voluntary educational campaigns, followed by supply-side policing and—sometimes—public health response...

People who inject drugs (PWID) have experienced the second highest number of HIV infections and HIV-related deaths of any risk group in the U.S. after men who have sex with men (MSM), and they also suffer from high prevalence of hepatitis C, other infectious diseases, and chronic health conditions. PWID in the U.S. are currently most affected by th...

Objective: To identify the prevalence of substance use and mental health problems among veterans and student service members/veterans (SSM/V) returning from Iraq and Afghanistan to New York City's low-income neighborhoods. Participants: A sample of 122 veterans attending college and 116 veterans not enrolled recruited using respondent-driven sam...

This chapter looks at the history and purpose of America's drug law enforcement and how they inform current issues. It examines three current issues in drug law enforcement: quality-of-life policing, mass incarceration, and marijuana legalization. These major issues represent some of the historical residue of previous drug law enforcement practices...

Abstract: “The Discovery and Treatment of Juvenile Drug Use in Post-World War II Los Angeles” Juvenile drug use in Los Angeles both climbed and transformed in radical ways during the post-World War II era. While marijuana use was increasing among boys in 1950, juveniles were popping barbiturates or goofballs (such as Seconal and Nembutal) and amph...

http://www.fedprac.com/specialty-focus/substance-use-disorder/article/veterans-health-and-opioid-safety-contexts-risks-and-outreach-implications/f1b8d3a3c20d095699780a0870dc23e2.html

As Caulkins et al. [1] note, the prevalence of illegal drug use is often cast as an overall indicator of the size of the national drug problem [e.g. 2], the annual change is often used as a performance measure of policy efficacy, but the true costs of drug abuse can be better understood by examining a richer set of indices. To this end, they calcul...

This article examines recent combat veterans' experiences of “first-person shooter” (FPS) gaming and its relationship to posttraumatic stress disorder (PTSD). Current PTSD treatment approaches increasingly use virtual reality (VR) technologies, which have many similarities with FPS games. To explore these similarities, this article presents six cas...

This paper places America's "war on drugs" in perspective in order to develop a new metaphor for control of drug misuse. A brief and focused history of America's experience with substance use and substance use policy over the past several hundred years provides background and a framework to compare the current Pharmacological Revolution with Americ...

This article presents interview and focus group data from veterans of recent conflicts in Iraq and Afghanistan about their use of cannabis as a coping tool for dealing with posttraumatic stress disorder. Veterans’ comparisons of cannabis, alcohol, and psychopharmaceuticals tended to highlight advantages to cannabis use as more effective and less co...

Many veterans face various mental health challenges after separation. This study examines change over 14 months in mental health and related factors among 242 veterans returning to low-income predominately minority sections of New York City. Mental health treatment provided more than reductions in symptoms of PTSD and depression. It also resulted i...

This paper presents an overview of substance use patterns of recent veterans returning to low-income predominately minority communities over four periods of the military-veteran career. Respondent driven sampling (RDS) was used so that unbiased estimates could be obtained for the characteristics of the target population. The majority of participant...

This special issue examines major structural, sociocultural, and behavioral issues surrounding substance use and misuse among US military personnel and veterans who served in recent military conflicts in Iraq and Afghanistan. This introduction provides a brief historical review of the US's experiences of the linkages between war and substance use,...

Prescription opioid (PO) misuse represents a major health risk for many service members and veterans. This paper examines the pathways to misuse among a sample of US veterans who recently returned from Iraq and Afghanistan to low-income, predominately minority sections of New York City. Recreational PO misuse was not common on deployment. Most PO m...

Estimates of substance use and other mental health disorders of veterans (N = 269) who returned to predominantly low-income minority New York City neighborhoods between 2009 and 2012 are presented. Although prevalences of posttraumatic stress disorder, traumatic brain injury, and depression clustered around 20%, the estimated prevalence rates of al...

This paper describes veterans' overdose risks and specific vulnerabilities through an analysis of qualitative data collected from a sample of recently separated, formerly enlisted OEF/OIF veterans in the New York City area. We illustrate how challenges to the civilian readjustment process such as homelessness, unemployment, and posttraumatic stress...

Many veterans returning from Afghanistan and Iraq experience serious mental health (MH) concerns including substance use disorders (SUD), post-traumatic stress disorder, traumatic brain injury, depression, or serious psychological distress (SPD). This article uses data from the 2004 to 2010 National Survey on Drug Use and Health to examine the prev...

Purpose – In this chapter, we expand the definition of disaster through combining the tenets of disaster studies with the literature on risks and consequences of war and conflict-related displacement and dislocation, with a focus on the challenges that drug misuse and changing drug markets present in these contexts. We conclude with policy recommen...

This paper presents an analysis of prescription drug use while soldiers are on active duty in Iraq and Afghanistan and illegal use after returning to civilian life. Many soldiers are given prescription drugs while deployed to treat pain, sleep disorders, and anxiety, and little is known about their drug use and related health problems after they re...

Accidental overdose fatalities are a serious concern for the public health community. Between 1980 and 1990, there was an average of 58 overdose fatalities per year in Allegheny County. This number increased to 100 overdose fatalities reported in 1998 and has increased since, peaking in 2007 with 253 overdose fatalities before declining slightly to...

Prevention Point Pittsburgh (PPP) is a public health advocacy organization that operates Allegheny County's only needle exchange program. In 2002, PPP implemented an Overdose Prevention Program (OPP) in response to an increase in heroin-related and opioid-related overdose fatalities in the region. In 2005, the OPP augmented overdose prevention and...

Hurricane Katrina accomplished what no law enforcement initiative could ever achieve: It completely eradicated the New Orleans drug market. However, Katrina did little to eliminate the demand for drugs. This article documents the process of the drug market reconstitution that occurred 2005–2008 based on in-depth interviews and focus groups with pre...