
Brandon D.L. MarshallBrown University · Department of Epidemiology
Brandon D.L. Marshall
PhD
About
463
Publications
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Introduction
Brandon Marshall is a Professor of Epidemiology at the Brown University School of Public Health. His research interests focus on substance use epidemiology and examining the social, environmental, and structural determinants of health of drug-using populations. His work seeks to inform public health and policy interventions that improve the health of people who use drugs.
Additional affiliations
January 2015 - May 2016
January 2012 - January 2015
December 2011 - December 2012
Education
September 2008 - May 2011
September 2006 - May 2008
September 2001 - May 2006
Publications
Publications (463)
Background
Buprenorphine and methadone are US Food and Drug Administration-approved medications for opioid use disorder (MOUD). Although utilization of MOUD was increasing pre-COVID-19, it is not well understood how this trend shifted during and “after” the COVID-19 pandemic in Rhode Island. This analysis will consider the differential utilization...
Background:
Emergency department (ED) visits are an opportunity to provide prevention services to people at high risk of overdose. Considering patients' resources to initiate and sustain recovery ("recovery capital") may be useful for tailoring ED services, although its relevance in this population is unknown.
Methods:
This secondary analysis us...
Background:
HIV continues to disproportionately impact men who have sex with men (MSM) in the United States (US). Pre-exposure prophylaxis (PrEP) is effective, but disparities persist. Limited studies have conducted systematic evaluations of social determinants of health (SDOH) and their effects on PrEP persistence among MSM.
Setting:
We enrolle...
From 2014 to 2017, the drug overdose death rate per 100,000 in New York City (NYC) increased by 81%, with 57% of overdoses in 2017 involving the opioid fentanyl. In response, overdose education and naloxone dispensing (OEND) efforts were expanded in NYC, informed by neighborhood-level and population-level opioid overdose fatality rates. We describe...
Aim: The drug supply in New England is increasingly dominated by fentanyl. In 2022, approximately 75% of overdose deaths in Rhode Island (RI) involved fentanyl. This study examines concordance between self-reported suspected fentanyl exposure and fentanyl presence in urine drug testing (UDT).
Methods: We utilized baseline data from the Rhode Islan...
Aim: There are increasing reports of benzodiazepine adulteration in Canada's unregulated drug supply. In many Canadian settings, harm reduction drug checking services (DCS) are available for people to identify the ingredients in their drugs, including adulterants. This study examines the relationship between suspected unintentional benzodiazepine c...
Background and Aims
During the COVID‐19 pandemic, there was a surge in opioid overdose deaths (OODs) in Massachusetts, USA, particularly among Black and Hispanic/Latinx populations. Despite the increasing racial and ethnic disparities in OODs, there was no compensatory increase in naloxone distributed to these groups. We aimed to evaluate two commu...
Background
Certified peer recovery specialists (CPRS) and licensed clinical social workers (LCSWs) can facilitate substance use disorder (SUD) treatment engagement for emergency department (ED) patients at risk for overdose. Predictors of treatment engagement after such behavioral services are unknown.
Methods
This secondary analysis included Rhod...
Objective: Fatal and nonfatal overdoses involving opioids have increased to crisis levels in recent years. Laypersons have been increasingly tasked with responding to these events by administering naloxone, performing rescue breaths/cardiopulmonary resuscitation, and calling for medical assistance. However, little is known about the development of...
Importance
Since 2014, Medicaid expansion has been implemented in many states across the US, increasing health care access among vulnerable populations, including formerly incarcerated people who experience higher mortality rates than the general population.
Objective
To examine population-level association of Medicaid expansion with postrelease m...
Background
Fentanyl is increasingly pervasive in the unregulated drug supply and is a driver of drug overdose deaths in the United States. The aims of this study were to characterize and identify correlates of fentanyl preference among people who use drugs (PWUD) in Rhode Island (RI).
Methods
Using bivariate analysis, we examined associations betw...
Treatment of opioid use disorder (OUD) with buprenorphine improves outcomes and mortality among people with HIV (PWH). However, engagement is low and is influenced by comorbidities. We examined the impact of patterns of co-occurring pain, substance use disorders (SUDs), and mental health diagnoses on buprenorphine initiation and retention in PWH. T...
Background
Pre-exposure prophylaxis (PrEP) is a highly effective pharmaceutical intervention that prevents HIV infection, but PrEP uptake across the US has been slow among men who have sex with men (MSM), especially among Black/African American (B/AA) and Hispanic /Latino (H/L) MSM. This study investigates the acceptability and essential components...
Background
Over 107,000 people died in the United States (U.S.) from drug overdose in 2022, with over one million overdose deaths since 1999. The U.S. drug market is characterized by a highly toxic, unregulated, and rapidly changing supply. Understanding the extent of exposure to fentanyl among people who use drugs (PWUD) will guide public health i...
Background: As in much of the United States, there have been significant increases in overdose deaths among non-Hispanic Black and Hispanic/Latinx populations in Rhode Island over the past decade. Given the shifting dynamics of the overdose epidemic, there is an urgent need for focused interventions that address the specific needs of diverse commun...
Background and aims
Emergency departments (EDs) provide an opportunity to identify people at risk of overdose and reduce the risk. We evaluated the effect of an ED behavioral intervention delivered by peer recovery support specialists (PRSSs) on non‐fatal opioid overdose.
Design
Two‐arm, randomized trial.
Setting
Two EDs in Rhode Island, USA.
Pa...
Introduction
Improving the delivery of existing evidence‐based interventions to prevent and diagnose HIV is key to Ending the HIV Epidemic in the United States. Structural barriers in the access and delivery of related health services require municipal or state‐level policy changes; however, suboptimal implementation can be addressed directly throu...
Objective:
This study examined if emergency department (ED) operational metrics, such as wait time or length of stay, are associated with interest in substance use disorder (SUD) treatment referral among patients at high risk of opioid overdose.
Methods:
In this observational study, 648 ED patients at high risk of opioid overdose completed a bas...
Introduction
Depressive symptoms are linked with pain, anxiety, and substance use. Research estimating whether a reduction in depressive symptoms is linked to subsequent reductions in pain and anxiety symptoms and substance use is limited.
Methods
Using data from the Veterans Aging Cohort Study, a multisite observational study of U.S. veterans, th...
Aim: We sought to model the cumulative, long-term effect of self-
reported opioid use using weighted cumulative exposure (WCE) models on change in Veterans Aging Cohort (VACS) Index score, a measure of HIV disease severity, among people with HIV (PWH).
Methods: ART-exposed PWH who enrolled from December 2005 to November 2017 in the AIDS Care Cohort...
Aim: The link between alcohol use disorder (AUD) and hepatic
decompensation (HD) among patients with cirrhosis has been well- described. Although tobacco use frequently co-occurs with AUD, its independent impact on HD is unknown. We aimed to assess the association between tobacco use and HD.
Methods: Electronic Health Record (EHR) data were extract...
As resolution for opioid-related claims and litigation against pharmaceutical manufacturers and other stakeholders, state and local governments are newly eligible for millions of dollars of settlement funding to address the overdose crisis in the United States. To inform effective use of opioid settlement funds, we propose a simple framework that h...
Background: Missouri's Overdose Field Report (ODFR) is a community-based reporting system which intends to capture overdoses which may not be otherwise recorded.Objectives: Describe the factors related to non-fatal overdoses reported to Missouri's ODFR.Methods: This study used a descriptive epidemiological approach to examine the demographics and c...
Practice guidelines recommend nonpharmacologic and nonopioid therapies as first-line pain treatment for acute pain. However, little is known about their utilization generally and among individuals with opioid use disorder (OUD) for whom opioid and other pharmacologic therapies carry greater risk of harm.
To determine the association between a pre-e...
Objective
Policy ramifications of the COVID-19 pandemic shape the concurrent housing and overdose crises in the USA. Housing insecurity is a known risk factor for overdose, yet how residential eviction may influence fatal overdose risk is understudied. We sought to evaluate the spatiotemporal relationship between neighbourhood-level residential evi...
BACKGROUND
Delays in hospital presentation limit access to acute stroke treatments. While prior research has focused on patient-level factors, broader ecological and social determinants have not been well studied. We aimed to create a geospatial map of prehospital delay and examine the role of community-level social vulnerability.
METHODS
We studi...
Rhode Island has experienced an ongoing and increasing burden of HIV and other sexually transmitted infections (STIs), with young gay, bisexual, and other men who have sex with men (GBMSM) accounting for 83% of new HIV diagnoses in 2021. During this period, GBMSM were also disproportionately affected by syphilis, particularly young GBMSM of color a...
Importance
Many US states are substantially increasing community-based naloxone distribution, supported in part through settlements from opioid manufacturers and distributors.
Objectives
To evaluate the potential impact of increased naloxone availability on opioid overdose deaths (OODs) and explore strategies to enhance this impact by integrating...
Background
Amidst increasing opioid-related fatalities in adolescents and young adults (AYA), there is an urgent need to enhance the quality and availability of developmentally appropriate, evidence-based treatments for opioid use disorder (OUD) and improve youth engagement in treatment. Involving families in treatment planning and therapy augments...
Background
Overdose prevention centers (OPCs) are being implemented in the United States as a strategy to reduce drug-related mortality and morbidity. Previous studies have suggested that people who use drugs (PWUD) with a history of criminal legal system (CLS) involvement (e.g. current probation/parole) are at greater risk of overdose but may also...
Background
Overdose prevention centers (OPCs), also known as supervised injection facilities and safe consumption sites, are evidenced-based interventions for preventing overdose deaths and drug-related morbidities. The pathways to legalizing OPCs in the USA have confronted multiple social, political, and legal obstacles. We conducted a multi-site,...
Introduction: 80% of strokes occur in the company of others and 70% take place at home. However, research on prehospital delay has overlooked the social nature of stroke detection and triage. In the Time is Brain study, we aim to understand how a patient’s social network affects the decision to seek medical care during stroke symptom onset.
Methods...
Background: Acute reperfusion treatment reduces morbidity in Acute Ischemic Stroke (AIS). National guidelines use Last Known Well (LKW) estimates to determine eligibility. When LKW and symptom onset (SO) are “coupled,” treatment eligibility determination is easier. However, eligibility becomes complex when times are “decoupled,” such as in wake-up...
Background
Drug overdose persists as a leading cause of death in the United States, but resources to address it remain limited. As a result, health authorities must consider where to allocate scarce resources within their jurisdictions. Machine learning offers a strategy to identify areas with increased future overdose risk to proactively allocate...
Background
The US Ending the HIV Epidemic (EHE) initiative aims to reduce national HIV incidence 90% by 2030 and to address the disproportionate burden of HIV among different racial/ethnic populations. Florida's state-wide 2022–2026 Integrated HIV Prevention and Care Plan outlines objectives for reaching EHE goals. In Miami-Dade County, we determin...
Introduction
We evaluated racial/ethnic differences in the receipt of naloxone distributed by opioid overdose prevention programs (OOPPs) in New York City (NYC).
Methods
We used naloxone recipient racial/ethnic data collected by OOPPs from April 2018 to March 2019. We aggregated quarterly neighborhood-specific rates of naloxone receipt and other c...
Background
Both increases and decreases in patients’ prescribed daily opioid dose have been linked to increased overdose risk, but associations between 30-day dose trajectories and subsequent overdose risk have not been systematically examined.
Objective
To examine the associations between 30-day prescribed opioid dose trajectories and fatal opioi...
Background: Missouri’s Overdose Field Report (ODFR) is a community-based reporting system which intends to capture overdoses which may not be otherwise recorded. Objectives: Describe the factors related to non-fatal overdoses reported to Missouri’s ODFR. Methods: This study used a descriptive epidemiological approach to examine the demographics and...
Importance
Nonpharmacologic treatments are important for managing chronic pain among persons with opioid use disorder (OUD), for whom opioid and other pharmacologic therapies may be particularly harmful. Racial and ethnic minority individuals with chronic pain and OUD are vulnerable to suboptimal pain management due to systemic inequities and struc...
Background and Aims
The onset of the coronavirus disease 2019 (COVID‐19) pandemic was associated with a surge in opioid overdose deaths in Massachusetts, particularly affecting racial and ethnic minority communities. We aimed to compare the impact of the pandemic on opioid overdose fatalities and naloxone distribution from community‐based programs...
Background:
Substance use patterns are diverse, and multiple substances are often involved in fatal and nonfatal overdoses. Additionally, polysubstance use is associated with greater difficulty accessing and remaining in substance use disorder (SUD) treatment. The aim of this study was to identify substance use patterns and determine their associa...
Background and Objectives
Clinical practice guidelines recommend noninvasive nonpharmacologic pain therapies; however, reviews that assess the literature pertaining to nonpharmacologic pain management among older adults and people with long-term disabilities who are disproportionately impacted by pain are lacking. This scoping review aimed to syste...
UNSTRUCTURED
As the field of public health rises to the demands of real-time surveillance and rapid data-sharing needs in a post-pandemic world, it is time to examine our frameworks for the dissemination and accessibility of such data. Distinct challenges exist when working to develop a shared public health language and narratives based on data. It...
As the field of public health rises to the demands of real-time surveillance and rapid data-sharing needs in a postpandemic world, it is time to examine our approaches to the dissemination and accessibility of such data. Distinct challenges exist when working to develop a shared public health language and narratives based on data. It requires that...
Introduction
Increasingly, Fourier-transform infrared (FTIR) spectroscopy is being used as a harm reduction tool to provide people who use drugs real-time information about the contents of their substances. However, FTIR spectroscopy has been shown to have a high detection limit for fentanyl and interpretation of results by a technician can be subj...
Objective:
Accurate naloxone distribution data are critical for planning and prevention purposes, yet sources of naloxone dispensing data vary by location, and completeness of local datasets is unknown. We sought to compare available datasets in Massachusetts, Rhode Island, and New York City (NYC) to a commercially available pharmacy national clai...
Purpose
We aimed to synthesize insights from systems science approaches applied to domestic and gender-based violence.
Methods
We conducted a systematic review of systems science studies (systems thinking, group model-building, agent-based modeling [ABM], system dynamics [SD] modeling, social network analysis [SNA], and network analysis [NA]) appl...
Prior applications of machine learning to population health have relied on conventional model assessment criteria, limiting the utility of models as decision support tools for public health practitioners. To facilitate practitioners’ use of machine learning as a decision support tool for area-level intervention, we developed and applied 4 practice-...
Introduction: We evaluated racial/ethnic differences in the receipt of naloxone distributed by opioid overdose prevention programs (OOPPs) in New York City (NYC).
Methods: We used naloxone recipient racial/ethnic data collected by OOPPs from April 2018 to March 2019. We aggregated quarterly neighborhood-specific rates of naloxone receipt and other...
Background: Rates of psychostimulant use, misuse, and hospitalization have increased markedly over the past decade. The objective of this study was to estimate the association between receipt of a psychostimulant prescription in the past year and fatal, unintentional psychostimulant-involved overdose. Methods: We conducted a population-based case-c...
Objectives: Our objective is to determine if specific sociodemographic characteristics were associated with perceived drug-related discrimination among people who use drugs (PWUD) presenting for care in the emergency department (ED).
Methods: We conducted a secondary analysis of data from the Navigator trial, a randomized control trial of two behav...
Introduction:
Pain treatment guidelines prioritize nonopioid therapies over opioid medications to prevent opioid-related harms. We examined trends in receipt and intensity of nonpharmacologic, nonopioid medication, and opioid therapies among Medicare beneficiaries.
Methods:
Using a 20% national random sample of Medicare data from 2016 to 2019, w...
Objective
Efforts to prevent opioid overdose mortality have rapidly expanded, including community-based distribution of naloxone to laypeople. In turn, responding to the opioid overdose crisis has increasingly fallen on the shoulders of community laypeople. Yet, little attention has been given to studying the mental health consequences of respondin...
The association between recent release from incarceration and dramatically increased risk of fatal overdose is well-established at the individual level. Fatal overdose and. arrest/release are spatially clustered, suggesting that this association may persist at the neighborhood level. We analyzed multicomponent data from Rhode Island, 2016-2020, and...
Differences in infectious disease risk, acquisition, and severity arise from intersectional systems of oppression and resulting historical injustices that shape individual behavior and circumstance. We define historical injustices as distinct events and policies that arise out of intersectional systems of oppression. We view historical injustices a...
Human Immunodeficiency Virus (HIV) interventions among people who use drugs (PWUD) often have spillover, also known as interference or dissemination, which occurs when one participant’s exposure affects another participant’s outcome. PWUD are often members of networks defined by social, sexual, and drug-use partnerships and their receipt of interve...
Background
The ongoing COVID-19 pandemic has disproportionately affected structurally vulnerable populations including people who use drugs (PWUD). Increased overdose risk behaviors among PWUD during the pandemic have been documented, with research underscoring the role of influencing factors such as isolation and job loss in these behaviors. Here,...
Background
Increasing numbers of opioid overdoses have been observed during the COVID-19 pandemic, likely reflecting the pandemic’s multiple effects on this already vulnerable population. People in recovery from opioid use disorder (OUD) have reported disproportionate psychosocial distress and isolation, as well as significant disruptions in access...
Background and aims:
Low outcome prevalence, often observed with opioid-related outcomes, poses an underappreciated challenge to accurate predictive modeling. Outcome class imbalance, where non-events (i.e., negative class observations) outnumber events (i.e., positive class observations) by a moderate to extreme degree, can distort measures of pr...
Justice-involved youth with clinically significant co-occurring psychiatric and substance-related problems are at increased risk for recidivism. Less is known about how psychiatric symptoms (i.e., internalizing and externalizing) and substance-related problems (i.e., alcohol and cannabis) interact to predict recidivism, especially at first court co...
Ensuring that patients with opioid use disorder (OUD) have access to optimal medication therapies is a critical challenge in substance use epidemiology. The paper by Rudolph et al. (Am J Epidemiol. 2022; XXX(X):XXXX-XXXX) demonstrated that sophisticated data-adaptive statistical techniques can be used to learn optimal, individualized treatment rule...
A growing body of literature has documented high rates of adverse childhood experiences (ACEs) and their effects on behavioral health among adolescents impacted by the juvenile legal system. Most research with justice-impacted youth assesses the ten standard ACEs, encompassing abuse, neglect, and household dysfunction. This body of work has largely...
Importance
In 2021, the state of Rhode Island distributed 10 000 additional naloxone kits compared with the prior year through partnerships with community-based organizations.
Objective
To compare various strategies to increase naloxone distribution through community-based programs in Rhode Island to identify one most effective and efficient strat...
Background
Among veterans in care reporting opioid use, we investigated the association between ceasing opioid use on subsequent reduction in report of other substance use and improvements in pain, anxiety, and depression.
Methods
Using Veterans Aging Cohort Study survey data collected between 2003 to 2015, we emulated a hypothetical randomized tr...
We developed an agent-based model using a trial emulation approach to quantify effect measure modification of spillover effects of pre-exposure prophylaxis (PrEP) for HIV among men who have sex with men (MSM) in the Atlanta-Sandy Springs-Roswell metropolitan area, Georgia. PrEP may impact not only the individual prescribed, but also their partners...
Introduction:
Urolithiasis causes severe acute pain and is commonly treated with opioid analgesics in the emergency department (ED). We examined opioid analgesic use after episodes of acute pain.
Methods:
Using data from a longitudinal trial of ED patients with urolithiasis, we constructed multivariable models to estimate the adjusted probabilit...
Background
Narrow or non-existent Good Samaritan Law protections and harsh drug selling statutes in the USA have been shown to deter bystanders from seeking medical assistance for overdoses. Additionally, little is known about the actions that police take when responding to overdose events. The objectives of this study were to assess the prevalence...
Background
Overdose deaths have increased dramatically in the United States, including in Rhode Island. In July 2021, the Rhode Island government passed legislation supporting a two-year pilot program authorizing supervised consumption sites (SCSs) in response to this crisis. We estimated the costs and benefits of a hypothetical SCS in Providence,...
Background
Racial/ethnic minorities have experienced disproportionate opioid-related overdose death rates in recent years. In this context, we examined inequities in community-based naloxone access across racial/ethnic groups in Massachusetts.
Methods
We used data from: the Massachusetts Department of Public Health on community-based overdose educ...
Background:
Despite recent HIV outbreaks among people who inject drugs (PWID) in nonurban US settings, syringe service programs (SSP) are often inaccessible in these communities. Furthermore, pre-exposure prophylaxis (PrEP) awareness and coverage for PWID is limited. We aimed to model the impact of PrEP on HIV transmission among PWID in a rural se...
Objective:
Trauma, violence, and their consequences for population health are shaped by complex, intersecting forces across the life span. We aimed to illustrate the strengths of agent-based modeling (ABM), a computational approach in which population-level patterns emerge from the behaviors and interactions of simulated individuals, for advancing...
Background
Scant research has examined the influence of overdoses occurring in social networks (i.e., knowing someone who has overdosed) on individual overdose risk. We sought to characterize drug use behaviors of individuals following the overdose of someone in their social network.
Methods
We conducted semi-structured interviews with 25 people w...
Objective:
This objective of this review is to describe the scope of the literature on the access to and use of nonpharmacologic therapies to manage chronic pain among people with disabilities and older adults.
Introduction:
Clinical guidelines recommend nonpharmacologic interventions as first-line therapy for chronic pain management. The import...