Publications by authors named "Shapei Yan"

Background: Calendar-based timeline follow-back (TLFB) instruments have been used to assess alcohol use, smoking, and other behaviors. We assessed test-retest reliability of an adapted TLFB addressing opioid-related outcomes over 120 days among opioid overdose survivors using nonprescribed opioids.

Methods: The Repeated-dose Behavioral intervention to reduce Opioid Overdose Trial utilized a TLFB that collected data over the preceding 120 days.

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Article Synopsis
  • The study aimed to explore how race and ethnicity (Black, White, Hispanic/Latino) relate to the rejection of referrals from private postacute care facilities for hospitalized individuals with opioid use disorder (OUD).
  • Researchers utilized electronic records from Boston Medical Center to analyze data from 159 hospitalizations, finding that non-Hispanic Black individuals faced significantly higher odds of referral rejection compared to non-Hispanic White individuals (1.83 times more likely).
  • The study concludes that racial discrimination is evident in postacute care admissions for OUD, highlighting the need for initiatives to improve racial equity in healthcare access.
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Article Synopsis
  • The study focuses on involuntary civil commitment (ICC) for substance use disorders, specifically how outreach teams in Massachusetts perceive and promote ICC in their work following drug overdoses.
  • Data collected from surveys and interviews indicated that 36% of outreach programs focused on ICC at least half the time, influencing their treatment philosophies and collaborations.
  • Key themes from the interviews revealed mixed views on ICC, with some considering it essential for engagement in treatment, while others were skeptical about its effectiveness and worried about possible negative consequences.
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Importance: Despite the proliferation of pharmacy standing-order naloxone dispensing across many US states before the change to over-the-counter status, few policy analyses have evaluated the implementation of pharmacy naloxone standing orders in addressing opioid overdose fatality among communities.

Objective: To determine whether the implementation of pharmacy standing-order naloxone was associated with lower opioid fatality rates compared with communities without pharmacies with standing-order naloxone.

Design, Setting, And Participants: This retrospective multisite study was conducted with an interrupted time series analysis across 351 municipalities in Massachusetts over 24 quarters (from January 1, 2013, through December 31, 2018).

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Importance: Transitions in insurance coverage may be associated with worse health care outcomes. Little is known about insurance stability for individuals with opioid use disorder (OUD).

Objective: To examine insurance transitions among adults with newly diagnosed OUD in the 12 months after diagnosis.

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Importance: Serious injection-related infections (SIRIs) cause significant morbidity and mortality. Medication for opioid use disorder (MOUD) improves outcomes but is underused. Understanding MOUD treatment after SIRIs could inform interventions to close this gap.

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Background: Little is known about how use patterns of medications for opioid use disorder (MOUDs) evolve from pre-incarceration to post-incarceration among incarcerated individuals with opioid use disorder. This article describes pre- and post-incarceration MOUD receipt during a period when naltrexone was the only type of MOUD offered in a state prison system, the Massachusetts Department of Correction (MADOC).

Methods: A retrospective cohort study of individuals with opioid use disorder who had an incarceration episode in MADOC during January 2015 to March 2019.

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Medications for opioid use disorder (MOUD) increase retention in care and decrease mortality during active treatment; however, information about the comparative effectiveness of different forms of MOUD is sparse. Observational comparative effectiveness studies are subject to many types of bias; a robust framework to minimize bias would improve the quality of comparative effectiveness evidence. This paper discusses the use of target trial emulation as a framework to conduct comparative effectiveness studies of MOUD with administrative data.

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Background: Post-overdose outreach programs engage overdose survivors and their families soon after an overdose event. Staff implementing these programs are routinely exposed to others' trauma, which makes them vulnerable to secondary traumatic stress (STS) and compassion fatigue. The purpose of this study was to explore experiences of STS and associated upstream and downstream risk and protective factors among program staff.

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Importance: Agonist medications for opioid use disorder (MOUD), buprenorphine and methadone, in carceral settings might reduce the risk of postrelease opioid overdose but are uncommonly offered. In April 2019, the Massachusetts Department of Correction (MADOC), the state prison system, provided buprenorphine for incarcerated individuals in addition to previously offered injectable naltrexone.

Objective: To evaluate postrelease outcomes after buprenorphine implementation.

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Background: Public health-public safety partnerships for post-overdose outreach have emerged in many communities to prevent future overdose events. These efforts often identify overdose survivors through emergency call data and seek to link them with relevant services. The aim of this study was to describe how post-overdose outreach programs in Massachusetts manage the confidentiality of identifiable information and privacy of survivors.

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Background: Post-overdose outreach programs have proliferated in response to opioid overdose. Implementing these programs is associated with reductions in overdose rates, but the role of specific program characteristics in overdose trends has not been evaluated.

Methods: Among 58 Massachusetts municipalities with post-overdose outreach programs, we examined associations between five domains of post-overdose outreach program characteristics (outreach contact rate, naloxone distribution, coercive practices, harm reduction activities, and social service provision or referral) and rates of fatal opioid overdoses and opioid-related emergency medical system responses (i.

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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 claims dataset (Symphony Health Solutions).

Data Sources And Study Setting: We utilized retail pharmacy naloxone dispensing data from NYC (2018-2019), Rhode Island (2013-2019), and Massachusetts (2014-2018), and pharmaceutical claims data from Symphony Health Solutions (2013-2019).

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Article Synopsis
  • Nonfatal opioid overdoses significantly increase the risk of subsequent fatal overdoses, highlighting the need for effective outreach programs to connect overdose survivors with addiction treatment and harm reduction services.
  • This study aimed to assess whether municipalities in Massachusetts with postoverdose outreach programs experienced lower opioid fatality rates compared to those without such programs between 2013 and 2019.
  • Data collected from 93 municipalities showed that while the outreach programs were implemented in 62% of these areas, the study found no significant reduction in opioid fatality rates after the implementation of these programs.
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Referrals of hospitalized patients with opioid use disorder (OUD) to postacute medical care facilities are commonly rejected. We linked all electronic referrals from a Boston safety-net hospital in 2018 to clinical data and used multivariable logistic regression to examine the association between OUD diagnosis and rejection from postacute medical care. Hospitalized patients with OUD were referred to more facilities than patients without OUD (8.

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Background: Naloxone is a prescription medication that reverses opioid overdoses. Allowing naloxone to be dispensed directly by a pharmacist without an individual prescription under a naloxone standing order (NSO) can expand access. The community-level factors associated with naloxone dispensed under NSO are unknown.

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Background And Aims: Opioid-related overdose death rates continue to rise in the United States, especially in racial/ethnic minority communities. Our objective was to determine if US municipalities with high percentages of non-white residents have equitable access to the overdose antidote naloxone distributed by community-based organizations.

Methods: We used community-based naloxone data from the Massachusetts Department of Public Health and the Rhode Island non-pharmacy naloxone distribution program for 2016-18.

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Article Synopsis
  • Post-overdose outreach programs in Massachusetts blend police and public health efforts to engage overdose survivors, often using 911 call data and warrant checks before outreach visits.
  • A survey showed that around 57% of these programs conduct warrant checks, leading to various strategies, including outreach without addressing warrants or delaying until warrants are cleared.
  • Interviews highlight the complexities of warrant checking, revealing that motivations, tensions in police roles, and the impact on outreach strategies can lead to unintended consequences.
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Background: Urine drug testing (UDT) is a recommended risk mitigation strategy for patients prescribed opioids for chronic pain, but evidence that UDT supports identification of substance misuse is limited.

Objective: Identify the prevalence of UDT results that may identify substance misuse, including diversion, among patients prescribed opioids for chronic pain.

Design: Retrospective cohort study.

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Background: As a response to mounting overdose fatalities, cross-agency outreach efforts have emerged to reduce future risk among overdose survivors. We aimed to characterize such programs in Massachusetts, with focus on team composition, approach, services provided, and funding.

Methods: We conducted a two-phase cross-sectional survey of public health and safety providers in Massachusetts.

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Purpose: We sought to obtain baseline statistics regarding the amount of opioid tablets prescribed by oral and maxillofacial surgeons (OMSs) in the New England area after office-based procedures and to identify factors that might be predictors of their prescription patterns.

Materials And Methods: An anonymous online survey was e-mailed to practicing OMSs in the New England area. The survey explored the quantity of opioid medications prescribed for various procedures, how opioid precautions were given, practitioners' attitude toward opioid dependency, and whether certain surgeon- or patient-related factors influenced prescription behavior.

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One of the most fundamental and challenging questions in the cancer field is how immunity in patients with cancer is transformed from tumor immunosurveillance to tumor-promoting inflammation. Here, we identify the transcription factor STAT3 as the culprit responsible for this pathogenic event in lung cancer development. We found that antitumor type 1 CD4 T-helper (Th1) cells and CD8 T cells were directly counter balanced in lung cancer development with tumor-promoting myeloid-derived suppressor cells (MDSCs) and suppressive macrophages, and that activation of STAT3 in MDSCs and macrophages promoted tumorigenesis through pulmonary recruitment and increased resistance of suppressive cells to CD8 T cells, enhancement of cytotoxicity toward CD4 and CD8 T cells, induction of regulatory T cell (Treg), inhibition of dendritic cells (DC), and polarization of macrophages toward the M2 phenotype.

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Signal transducer and activator of transcription 3 (STAT3) is linked to multiple cancers, including pulmonary adenocarcinoma. However, the role of STAT3 in lung cancer pathogenesis has not been determined. Using lung epithelial-specific inducible knockout strategies, we demonstrate that STAT3 has contrasting roles in the initiation and growth of both chemically and genetically induced lung cancers.

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