Daniel H Ciccarone

Daniel H Ciccarone
University of California, San Francisco | UCSF · Department of Family and Community Medicine

MD, MPH
Principal Investigator of the Synthetics in Combination Study (SYNC) funded by NIH/NIDA.

About

112
Publications
67,627
Reads
How we measure 'reads'
A 'read' is counted each time someone views a publication summary (such as the title, abstract, and list of authors), clicks on a figure, or views or downloads the full-text. Learn more
5,856
Citations
Citations since 2016
42 Research Items
3945 Citations
20162017201820192020202120220200400600
20162017201820192020202120220200400600
20162017201820192020202120220200400600
20162017201820192020202120220200400600
Introduction
Dr. Daniel H Ciccarone is Professor of Family and Community Medicine, in the School of Medicine at the University of California, San Francisco. He does research in Addiction Medicine and Public Health. He is currently Principal Investigator of the NIH/NIDA funded 'Heroin in Transition' project.
Additional affiliations
July 2000 - present
University of California, San Francisco
July 2000 - present
University of California
Position
  • Professor
July 1994 - June 1996
University of California, Berkeley
Position
  • Medical Doctor

Publications

Publications (112)
Article
Background: Fentanyl-related deaths continue to increase in the United States; however, most national studies focus on fatal overdose. More research, including data on nonfatal overdose, is needed. Objective: We examined trends in characteristics of fatal and nonfatal fentanyl-related poisonings ("exposures") in the US. Methods: National Poiso...
Preprint
Full-text available
Background: Despite the widespread availability of naloxone, U.S. opioid overdose rates continue to rise. The “Cascade of Care” (CoC) is a public health approach that identifies steps in achieving specific outcomes and has been used to identify gaps in naloxone carry among individuals with opioid use disorder (OUD). We sought to apply this framewor...
Article
Background Prevalence of fentanyl-laced counterfeit prescription pills has been increasing in the US, possibly placing a wider population at risk for unintentional exposure. We aimed to determine whether there have been shifts in the number of fentanyl seizures and in the form of fentanyl seized in the US. Methods We examined quarterly national se...
Article
Full-text available
In the United States, HIV outbreaks are occurring in areas most affected by the opioid epidemic, including West Virginia (WV). Cultural Theory contends that multiple cultures co-exist within societies distinguished by their differing intensities of rules or norms of behavior (‘grid’) or degree of group allegiance/individual autonomy (‘group’). Acco...
Preprint
Aims. U.S. overdose (OD) deaths continue to escalate but are characterized by geographic and temporal heterogeneity. We previously validated a predictive statistical model to predict county-level OD mortality nationally from 2013 to 2018. Herein, we aimed to: 1) validate our model’s performance at predicting county-level OD mortality in 2019 and 20...
Article
Extending from the triple wave epidemic of opioid-related overdose deaths, a fourth wave of high mortality involving methamphetamine and cocaine use has been gathering force. This article provides a review of the published literature on stimulants including epidemiology, pharmacology, neurobiology, medical and psychiatric consequences, withdrawal m...
Article
Introduction People who inject drugs (PWID) are vulnerable to a range of harms, including vascular conditions such as chronic venous insufficiency (CVI), leg ulcers and deep vein thrombosis (DVT). The extent of vascular conditions has rarely been studied, despite contributing to considerable illness and disability among PWID. We assess the prevalen...
Article
Full-text available
Background The emergence of fentanyl around 2013 represented a new, deadly stage of the opioid epidemic in the USA. We aimed to develop a statistical regression approach to identify counties at the highest risk of high overdose mortality in the subsequent years by predicting annual county-level overdose death rates across the contiguous USA and to...
Article
Full-text available
Purpose of review: This review provides an update on recently published literature on the rise of illicit fentanyls, risks for overdose, combinations with other substances, e.g. stimulants, consequences, and treatment. Recent findings: Overdose due to illicit synthetic opioids (e.g. fentanyl and fentanyl analogs) continues to rise in the US both...
Article
Full-text available
The opioid crisis in the United States (US) has been defined by waves of drug- and locality-specific Opioid use-Related Epidemics (OREs) of overdose and bloodborne infections, among a range of health harms. The ability to identify localities at risk of such OREs, and better yet, to predict which ones will experience them, holds the potential to mit...
Chapter
The opioid overdose epidemic in the United States is of historic proportion. This chapter describes the scope and epidemiology of the crisis; using the framework of the “Triple Wave” each phase of the overdose epidemic – due to pills, heroin and illicit synthetic opioids – will be discussed separately in terms of regional distribution, demographics...
Article
Full-text available
Objective The University of California (UC) leadership sought to develop a robust educational response to the epidemic of opioid-related deaths. Because the contributors to this current crisis are multifactorial, a comprehensive response requires educating future physicians about safe and effective management of pain, safer opioid prescribing, and...
Article
Full-text available
Background: West Virginia is a largely rural state with strong ties of kinship, mutual systems of support and charitable giving. At the same time, wealth inequalities are extreme and the state's drug overdose fatality rate stands above all others in the USA at 51.5/100,000 in 2018, largely opioid-related. In recent years, harm reduction services ha...
Article
Objectives: To examine changes in presence of methamphetamine in toxicology testing among outpatients receiving healthcare in Boston, Massachusetts. Methods: A serial cross-sectional study of oral fluid drug test results over a 6-year period of all patient specimens submitted for testing as part of routine care across an academic medical center...
Article
Full-text available
Background Skin and soft tissue infections (SSTI) are a common but preventable cause of morbidity and mortality among people who inject drugs (PWID). They can be severe, and hospitalisations of PWID with SSTI are rising. The most common SSTI presentations are abscesses and cellulitis. Methods We used data from Care & Prevent, a cross-sectional com...
Article
Full-text available
Albuminuria is a key biomarker for cardiovascular disease and chronic kidney disease. Our study aimed to describe the prevalence of albuminuria amongst people who inject drugs in London and to test any potential associations with demographic characteristics, past diagnoses, and drug preparation and administration practices. We carried out a cross-s...
Article
Full-text available
Background: The United Kingdom is experiencing an increase in drug-related deaths and serious bacterial infections among its most vulnerable citizens. Cuts to essential services, coupled with a growing homeless population, create a challenging environment to tackle this public health crisis. In this paper, we highlight an underexplored environment...
Article
Background: The US has seen a rapid increase in synthetic opioid-related overdose deaths. We investigate Ohio, a state with one of the highest overdose death rates in 2017 and substantial numbers of deaths related to fentanyl, carfentanil, and other fentanyl analogs, to provide detailed evidence about the relationship between changes in the illici...
Article
Full-text available
Background and aims Using mathematical modeling to illustrate and predict how different heroin source-forms: “black tar” (BTH) and powder heroin (PH) can affect HIV transmission in the context of contrasting injecting practices. By quantifying HIV risk by these two heroin source-types we show how each affects the incidence and prevalence of HIV ove...
Article
Full-text available
Background: Venous access is a priority for people who inject drugs (PWID). Damage and scarring of peripheral veins can exacerbate health harms, such as skin and soft tissue infections (SSTI), and promote transitions to femoral and subcutaneous injecting. Brown heroin available in Europe requires acidification for injection preparation. In this pa...
Article
Full-text available
Aims: To summarise evidence on the frequency and predictors of healthcare utilisation among people who use illicit drugs. Design: Systematic search of MEDLINE, EMBASE and PsychINFO for observational studies reporting healthcare utilisation published between 1 January 2000 and 3 December 2018. We conducted narrative synthesis and meta-analysis fo...
Preprint
Full-text available
Background and Aims Using mathematical modeling to illustrate and predict how different heroin source-forms: “black tar” (BTH) and powder heroin (PH) can affect HIV transmission in the context of contrasting injecting practices. By quantifying HIV risk by these two heroin source-types we show how each affects the incidence and prevalence of HIV ove...
Article
Full-text available
To the Editor The review by Alambyan and colleagues¹ is an excellent critical summary of the literature on leukoencephalopathy due to “chasing the dragon” (ie, heroin smoking). However, the review misrepresents the urgency of the situation by getting a few issues on heroin source forms and use incorrect, especially as they pertain to the US situati...
Article
Full-text available
Commentary to: Illicit fentanyls in the opioid street market: desired or imposed?
Article
Full-text available
Background: In 2016, the number of overdose deaths involving illicitly-manufactured fentanyl (IMF) surpassed heroin and prescription opioid deaths in the United States for the first time, with IMF-involved overdose deaths increasing more than 500% across 10 states from 2013 to 2016. IMF is an extremely potent synthetic opioid that is regularly mix...
Article
Full-text available
Background Illicitly manufactured fentanyl and its analogues are appearing in countries throughout the world, often disguised as heroin or counterfeit prescription pills, with resulting high overdose mortality. Possible explanations for this phenomenon include reduced costs and risks to heroin suppliers, heroin shortages, user preferences for a str...
Article
Full-text available
Background: Internationally, overdose is the primary cause of death among people injecting drugs. However, since 2001, heroin-related overdose deaths in the United States (US) have risen sixfold, paralleled by a rise in the death rate attributed to synthetic opioids, particularly the fentanyls. This paper considers the adaptations some US heroin i...
Article
Full-text available
Background: Skin and soft tissue infections (SSTIs) are a leading cause of morbidity and mortality among people who inject drugs (PWID). International data indicate up to one third of PWID have experienced an SSTI within the past month. Complications include sepsis, endocarditis and amyloid A (AA) amyloidosis. AA amyloidosis is a serious sequela o...
Article
Full-text available
Background and Aims Chronic skin and soft tissue infections (SSTI) among people who inject drugs (PWID) can lead to AA‐amyloidosis: a serious, yet neglected, multi‐organ disease. We aim to synthesise findings on the epidemiology, risk factors, clinical outcomes, screening recommendations, and challenges to treatment for AA‐amyloidosis among PWID....
Article
Full-text available
The accepted wisdom about the US overdose crisis singles out prescribing as the causative vector. Although drug supply is a key factor, we posit that the crisis is fundamentally fueled by economic and social upheaval, its etiology closely linked to the role of opioids as a refuge from physical and psychological trauma, concentrated disadvantage, is...
Article
Full-text available
Since 2001, heroin-related overdose deaths in the United States have risen six-fold, a rise unaccounted for by the expanding user population. Has heroin become a more dangerous drug? Reports of fentanyl and its analogs, often concealed in or sold as heroin, have also increased sharply. This article investigates heroin injectors' perceptions and exp...
Article
Full-text available
Background US opioid overdose death rates have increased between 2000 and 2014. While, the increase in prescription opioid use has been linked to the increase in heroin use, there are reasons to view this relationship as a partial explanation for the recent increase in heroin-related harms. This study documents the differences in trends in prescrip...
Article
Full-text available
Background: The US is experiencing an unprecedented opioid overdose epidemic fostered in recent years by regional contamination of the heroin supply with the fentanyl family of synthetic opioids. Since 2011 opioid-related overdose deaths in the East Coast state of Massachusetts have more than tripled, with 75% of the 1374 deaths with an available...
Article
Full-text available
Since the 1990s, U.S. heroin consumers have been divided from the full range of available products: east of the Mississippi River, Colombian-sourced powder heroin (PH) dominates the market while, to the west, Mexican-sourced "black tar" (BTH) is the main heroin available. By conducting qualitative research in two exemplar cities, Philadelphia (PH)...
Article
Full-text available
Introduction: Little is known about trends in national rates of injection-related skin and soft tissue infections (SSTI) and their relationship to the structural risk environment for heroin users. Use of Mexican-sourced "Black Tar" heroin, predominant in western US states, may have greater risk for SSTI compared with eastern US powder heroin (Colo...
Article
This commentary revisits the political turmoil and scientific controversy over epidemiological study findings linking high HIV seroincidence to syringe exchange attendance in Vancouver in the mid-1990s. The association was mobilized polemically by US politicians and hard-line drug warriors to attack needle exchange policies and funding. In turn, pr...
Article
Full-text available
Heroin overdose, more accurately termed 'heroin-related overdose' due to the frequent involvement of other drugs, is the leading cause of mortality among regular heroin users. (Degenhardt et al., 2010) Heroin injectors are at greater risk of hospital admission for heroin-related overdose (HOD) in the eastern United States where Colombian-sourced po...
Article
Abstract Introduction Despite how often medical trainees witness the spectrum of unhealthy substance use, disproportionately little curricular time is devoted to this topic. This lack of curricular time and shortage of actionable skills often leads to feelings of hopelessness and cynicism when caring for affected patients. Towards the goals of help...
Article
Full-text available
The loss of functioning veins (venous sclerosis) is a root cause of suffering for long-term heroin injectors. In addition to perpetual frustration and loss of pleasure/esteem, venous sclerosis leads to myriad medical consequences including skin infections, for example, abscess, and possibly elevated HIV/HCV risks due to injection into larger jugula...
Article
Full-text available
Background and AimsHeroin-related overdose is linked to polydrug use, changes in physiological tolerance and social factors. Individual risk can also be influenced by the structural risk environment including the illicit drug market. We hypothesized that components of the US illicit drug market, specifically heroin source/type, price and purity, wi...
Article
This qualitative study documents the pathways to injecting heroin by users in Philadelphia and San Francisco before and during a pharmaceutical opioid pill epidemic. Data was collected through in-depth, semi-structured interviews (conducted between 2010 and 2012) that were, conducted against a background of longer-term participant-observation, ethn...
Article
Full-text available
The historical patterns of opiate use show that sources and methods of access greatly influence who is at risk. Today, there is evidence that an enormous increase in the availability of prescription opiates is fuelling a rise in addiction nationally, drawing in new initiates to these drugs and changing the geography of opiate overdoses. Recent effo...
Article
A major barrier to actualizing the public health impact potential of screening, brief intervention, and referral to treatment (SBIRT) is the suboptimal development and implementation of evidence-based training curricula for healthcare providers. As part of a federal grant to develop and implement SBIRT training in medical residency programs, the au...
Conference Paper
Full-text available
Background: Heroin and opiate addiction harms individuals, families, and communities. Local and anecdotal data suggest increased opiate overdoses since the early 1990s in the United States, but few studies have examined trends, correlates, or demographic changes in overdose-related hospital admissions in a nationally representative sample. This pro...
Conference Paper
Background: Local and anecdotal data suggest increasing opiate overdoses beginning in the mid-1990s in the US, but few studies have examined trends or demographic changes in opiate-related overdose hospital admissions in a nationally representative sample. Method: Using the Nationwide Inpatient Survey (NIS), we estimated the number of hospital ad...
Conference Paper
Background: A previous study showed that the number of hospitalizations for injection drug use (IDU)-related infective endocarditis (IE) increased by 66 percent nationwide between 2000 and 2003. We extend this analysis to a 15-year timeframe, 1993-2007, and explore associated factors for the observed IDU-related IE trends. Method: We used data fr...
Article
The high prevalence of stimulant abuse and its harmful consequences make the screening, diagnosis, and referral for treatment of persons with stimulant abuse a top concern for primary care providers. Having a working knowledge of use patterns, clinical symptomatology, end-organ effects, and advances in treatment of stimulant abuse is essential. Alt...
Article
The past two decades have seen an increase in heroin-related morbidity and mortality in the United States. We report on trends in US heroin retail price and purity, including the effect of entry of Colombian-sourced heroin on the US heroin market. The average standardized price ($/mg-pure) and purity (% by weight) of heroin from 1993 to 2004 was fr...
Article
Background: Heroin coming into the United States historically comes from three widely dispersed geographical regions: Southwest Asia, Southeast Asia and Mexico. A fourth source of US-bound heroin, from Colombia, originated in the early 1990s. The fact that the four heroin sources produce differing morphologies and qualities of heroin has not been...