Luther Elliott

New York University School of Global Public Health

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: 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...

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: 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...

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...

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 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...

BACKGROUND As drug-related morbidity and mortality continue to surge, police officers are on the front lines of the North American overdose crisis. Drug law enforcement shapes health risks among people who use drugs (PWUD), while also impacting occupational health and wellness of officers. Effective interventions to align law enforcement practices...

Background: As drug-related morbidity and mortality continue to surge, police officers are on the front lines of the North American overdose (OD) crisis. Drug law enforcement shapes health risks among people who use drugs (PWUD), while also impacting the occupational health and wellness of officers. Effective interventions to align law enforcement...

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...

The rapid emergence of novel psychoactive substances within the past decade has raised new concerns about the harms associated with unregulated drug use. Synthetic analogues—chemically related to established psychoactive substances like cannabis sativa and catha edulis—in particular have proliferated rapidly, allowing little opportunity for scienti...

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: This article reports on the first implementation of an online opioid-overdose prevention, recognition and response training for laypeople. The training was disseminated nationally in November 2014. Between 2000 and 2014, U.S. opioid deaths increased by 200%. The importance of complementary approaches to reduce opioid overdose deaths, s...

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...

Background: Internet Gaming Disorder (IGD) has become increasingly prevalent in youths worldwide and associated with physical and psychosocial impairments. DSM-5 proposed nine criteria for the potential diagnosis of IGD and noted that further empirical research on the psychometric properties of measurement instruments for IGD are warranted. In resp...

Using the case of synthetic cathinones (commonly referred to as 'bath salts' in the US context), this paper analyses structural factors surrounding novel psychoactive substances (NPS) as contributing to the unique risk environment surrounding their use. Drawing on interviews with 39 people who use bath salts from four U.S. cities and analysis of th...

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...

Recent natural disasters in the US have demonstrated the enormous potential for opioid treatment programs (OTP) to be rendered inoperable, disrupting methadone dispensing for their patients. Discontinuation of dispensing has severe consequences for OTP patients, ranging from withdrawal, resumption of injection behaviors bearing risk of blood-borne...

Over 300,000 patients with an opioid use disorder (OUD) receive methadone maintenance therapy from opioid treatment programs (OTPs) in the United States. Large numbers of these attend OTPs located in New York and New Jersey, areas (largely but not exclusively coastal) impacted by Hurricane Sandy (Sandy) on October 29th, 2012. Disruption of methadon...

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...

Background This article reports on the first web-based implementation of an opioid-overdose prevention, recognition and response training for professional first responders. The training was disseminated nationally over one listserv in November 2014. The same year, following Act 139, which mandated the provision of an online training for police offi...

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...

There is growing awareness that students’ experiences of stress may impede academic success, compromise mental health, and promote substance use. We examined these factors in an under-studied population, private/independent high school students, using a multi-method (qualitative and quantitative), iterative data collection and analytic process. We...

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...

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...

This study explored predictors of engagement with specific video game genres, and degree of problem play experienced by players of specific genres, during the early life course. Video game players ages 18-29 (n = 692) were recruited in and around video game retail outlets, arcades, conventions, and other video game related contexts in New York City...

The increasing rate of opiate pain reliever (OPR) use is a pressing concern in the United States. This article uses a drug epidemics framework to examine OPR use among arrestees surveyed by the Arrestee Drug Abuse Monitoring program. Results demonstrate regional and demographic variation in use across nine focal cities. High rates of OPR use on the...

This study explored the relationship between video gaming and age during childhood, adolescence, and emerging adulthood. It also examined whether "role incompatibility," the theory that normative levels of substance use decrease through young adulthood as newly acquired adult roles create competing demands, generalizes to video gaming. Emerging adu...

AIMS: To assess the contribution of patterns of video game play, including game genre, involvement, and time spent gaming, to problem use symptomatology. DESIGN: Nationally representative survey. SETTING: Online. PARTICIPANTS: Large sample (n=3,380) of adult video gamers in the US. MEASUREMENTS: Problem video game play (PVGP) scale, video game genr...

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...

Purpose – To examine video gamers’ attitudes about and perspectives on the controversial topic of video game “addiction.” Approach – Ethnographic interviews and participant observation with a group of 52 regular video gamers, most also reporting considerable experience with substance use and/or dependence. Findings – Gamers tended to endorse one of...

This study assessed how problem video game playing (PVP) varies with game type, or "genre," among adult video gamers. Participants (n=3,380) were adults (18+) who reported playing video games for 1 hour or more during the past week and completed a nationally representative online survey. The survey asked about characteristics of video game use, inc...

This paper examines the accounts of NYC marijuana smokers about the information and values underlying decisions about where to smoke. We do so to assess the deterrent value of NYC's "quality of life" policing of marijuana in public view. Participants indicated a general awareness of escalated marijuana policing and its attendant risks and almost un...

This study tested the hypothesis that playing video games while using or feeling the effects of a substance--referred to herein as "concurrent use"-is related to substance use problems after controlling for substance use frequency, video gaming as an enthusiastic hobby, and demographic factors. Data were drawn from a nationally representative onlin...

"Behavioral addictions" share biological mechanisms with substance dependence, and "drug interactions" have been observed between certain substances and self-reinforcing behaviors. This study examines correlates of patterns of and motivations for playing video games while using or feeling the effects of a substance (concurrent use). Data were drawn...

In recent years, cannabis potency and new methods for the drug's consumption have become heated issues. However, procedures for accurate measurement of cannabis consumption are still needed to assess the role of drug potency in rising rates of cannabis misuse disorders. This chapter presents a range of conceptual and methodological concerns related...

This article considers the online dialogue of an electronic mailing list devoted to discussion of a genre of music called Goa or psychedelic trance. Attending in particular to the ways legitimate participation is policed in this online forum, this article argues that the debate over the social potential of computer-mediated communication demands an...