This study describes coronavirus disease 2019 (COVID-19) case rates and deaths among federal and state prisoners and compares them with corresponding rates for the US population.
Drug overdose is now the leading cause of injury death in the United States. Most overdose fatalities involve opioids, which include prescription medication, heroin, and illicit fentanyl. Current ...data reveal that the overdose crisis affects all demographic groups and that overdose rates are now rising most rapidly among African Americans. We provide a public health perspective that can be used to mobilize a comprehensive local, state, and national response to the opioid crisis. We argue that framing the crisis from a public health perspective requires considering the interaction of multiple determinants, including structural factors (eg, poverty and racism), the inadequate management of pain, and poor access to addiction treatment and harm-reduction services (eg, syringe services). We propose a novel ecological framework for harmful opioid use that provides multiple recommendations to improve public health and clinical practice, including improved data collection to guide resource allocation, steps to increase safer prescribing, stigma-reduction campaigns, increased spending on harm reduction and treatment, criminal justice policy reform, and regulatory changes related to controlled substances. Focusing on these opportunities provides the greatest chance of making a measured and sustained impact on overdose and related harms.
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BFBNIB, INZLJ, NMLJ, NUK, OILJ, PNG, SAZU, UKNU, UL, UM, UPUK, VSZLJ, ZRSKP
IMPORTANCE: Opioid analgesic overdose mortality continues to rise in the United States, driven by increases in prescribing for chronic pain. Because chronic pain is a major indication for medical ...cannabis, laws that establish access to medical cannabis may change overdose mortality related to opioid analgesics in states that have enacted them. OBJECTIVE: To determine the association between the presence of state medical cannabis laws and opioid analgesic overdose mortality. DESIGN, SETTING, AND PARTICIPANTS: A time-series analysis was conducted of medical cannabis laws and state-level death certificate data in the United States from 1999 to 2010; all 50 states were included. EXPOSURES: Presence of a law establishing a medical cannabis program in the state. MAIN OUTCOMES AND MEASURES: Age-adjusted opioid analgesic overdose death rate per 100 000 population in each state. Regression models were developed including state and year fixed effects, the presence of 3 different policies regarding opioid analgesics, and the state-specific unemployment rate. RESULTS: Three states (California, Oregon, and Washington) had medical cannabis laws effective prior to 1999. Ten states (Alaska, Colorado, Hawaii, Maine, Michigan, Montana, Nevada, New Mexico, Rhode Island, and Vermont) enacted medical cannabis laws between 1999 and 2010. States with medical cannabis laws had a 24.8% lower mean annual opioid overdose mortality rate (95% CI, −37.5% to −9.5%; P = .003) compared with states without medical cannabis laws. Examination of the association between medical cannabis laws and opioid analgesic overdose mortality in each year after implementation of the law showed that such laws were associated with a lower rate of overdose mortality that generally strengthened over time: year 1 (−19.9%; 95% CI, −30.6% to −7.7%; P = .002), year 2 (−25.2%; 95% CI, −40.6% to −5.9%; P = .01), year 3 (−23.6%; 95% CI, −41.1% to −1.0%; P = .04), year 4 (−20.2%; 95% CI, −33.6% to −4.0%; P = .02), year 5 (−33.7%; 95% CI, −50.9% to −10.4%; P = .008), and year 6 (−33.3%; 95% CI, −44.7% to −19.6%; P < .001). In secondary analyses, the findings remained similar. CONCLUSIONS AND RELEVANCE: Medical cannabis laws are associated with significantly lower state-level opioid overdose mortality rates. Further investigation is required to determine how medical cannabis laws may interact with policies aimed at preventing opioid analgesic overdose.
Abstract Purpose The American Academy of Pediatrics recently recommended that pediatricians consider medication-assisted treatment (MAT) for adolescents with severe opioid use disorders. Little is ...known about adolescents' current use of MAT. Methods We use data on episodes of specialty treatment for heroin or opioid use (n = 139,092) from a database of publicly funded treatment programs in the U.S. We compare the proportions of adolescents and adults who received MAT, first using unadjusted comparison of proportions, then using logistic regression to adjust for potential confounders. Results Only 2.4% (95% confidence interval CI, 1.4%–3.7%) of adolescents in treatment for heroin received MAT, as compared to 26.3% (95% CI, 26.0%–26.6%) of adults. Only .4% (95% CI, .2%–.7%) of adolescents in treatment for prescription opioids received MAT, as compared to 12.0% (95% CI, 11.7%–12.2%) of adults. Regression-adjusted results were qualitatively similar. Conclusions Regulatory changes and expansions of Medicaid/CHIP coverage for MAT may be needed to improve MAT access.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK, ZRSKP
Insuring undocumented U.S. immigrants would be a key step toward achieving universal health care coverage. In a hostile national political climate, recent legislative moves in the California ...legislature provide test cases for laws that could be replicated in other states.
The proportion of undocumented immigrants in the United States who lack health insurance continues to be high — around 40%
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— even as the country’s overall uninsured rate has dropped to historic lows under the Affordable Care Act (ACA). Insuring undocumented immigrants would be an important step toward achieving universal coverage, but in an increasingly hostile national political climate, the likelihood of addressing this challenge at the federal level is low. Because the ACA continues a long-standing restriction on using federal funds to insure undocumented immigrants, covering this population will probably remain largely a state prerogative in terms of both . . .
Policy has been critical to achieving major public health advances, including in tobacco control, maternal and child health, and injury prevention. The opioid crisis illustrates five steps essential ...for using policy to produce substantial gains in population health.
The aim of the study is to describe sociodemographic characteristics, healthcare access, and health status of low-income essential, nonessential, and nonworkers during the COVID-19 pandemic.
Using ...survey data (2020-2021) from Wisconsin Medicaid enrollees ( N = 2528), we compared sociodemographics, healthcare access, and health status between essential, nonessential, and nonworkers.
Essential workers had less consistent health insurance coverage and more problems paying medical bills than nonessential and nonworkers. They reported better health than nonessential and nonworkers. They reported fewer work-limiting conditions and less outpatient healthcare utilization than nonworkers but similar rates as nonessential workers. Essential workers reported masking less frequently than nonworkers but similar frequency to nonessential workers, and lower COVID-19 vaccine willingness than nonessential and nonworkers.
Essential workers report better health, fewer protective behaviors, and more healthcare barriers than nonessential and nonworkers. Findings indicate essential worker status may be a social determinant of health.
Community health centers (CHCs) deliver affordable health services to underserved populations, especially uninsured and Medicaid enrollees. Since the early 2000s, CHCs have grown because of federal ...investments in CHC capacity and expansions of Medicaid eligibility. We review 24 relevant studies from 2000 to 2017 to evaluate the relationship between CHCs, policies that invest in services for low-income individuals, and access to care. Most included studies use quasi-experimental designs. Greater spending on CHCs improves access to care, especially for low-income and minority individuals. Medicaid expansions also increase CHC use. Some studies indicate that CHC investments complement Medicaid expansions to increase access cost-effectively. Further research should explore patient preferences and patterns of CHC utilization versus other sites of care and population subgroups for which expanding CHC capacity improves access to care most. Researchers should endeavor to use measures and sample definitions that facilitate comparisons with other estimates in the literature.
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Almost all states have insurance coverage mandates for childhood autism spectrum disorder treatment, yet little is known about how mandates affect spending and service use. We evaluated a 2011 Kansas ...law mandating comprehensive coverage of autism spectrum disorder treatments in the State Employee Health Plan. Data were extracted from the Kansas All-Payer Claims Database from 2009 to 2013 for enrollees of State Employee Health Plan and private health plans. The sample included children aged 0–18 years with >2 claims with an autism spectrum disorder diagnosis insured through State Employee Health Plan or a comparison group enrolled through private health plans. We estimated differences-in-differences regression models to compare trends among State Employee Health Plan to privately insured children. Average annual total spending on autism spectrum disorder services increased by US$912 (95% confidence interval: US$331–US$1492) and average annual out-of-pocket spending on autism spectrum disorder services increased by US$138 (95% confidence interval: US$53–US$223) among diagnosed children in the State Employee Health Plan relative to the comparison group following the mandate, representing 92% and 75% increases over baseline total and out-of-pocket autism spectrum disorder spending, respectively. Average annual quantity of outpatient autism spectrum disorder services increased by 15.0 services (95% confidence interval: 8.4–21.6) among children in the State Employee Health Plan, more than doubling the baseline average. Implementation of a comprehensive autism spectrum disorder mandate in the Kansas State Employee Health Plan was associated with substantial increases in service use and spending for autism spectrum disorder treatment among autism spectrum disorder–diagnosed children.
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This Viewpoint discusses the 2024 presidential election in the context of the addiction and overdose crisis in the US, which has been a unifying challenge and a source of major ideological division ...in US politics.
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