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Silwal A, Dayton ZA. Understanding the Political Frames of the Opioid Crisis: A Content Analysis of U.S. Senators' Tweets. HEALTH COMMUNICATION 2024:1-15. [PMID: 38862402 DOI: 10.1080/10410236.2024.2364465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2024]
Abstract
The opioid epidemic in the United States is a public health emergency that has triggered calls to action for policy reforms. However, variations exist between political parties and policymakers on how this issue is communicated to the public. With the substantial growth in the use of social media by policymakers as a tool for disseminating policy-related information affecting their constituents, examining their communication strategies on public health emergency issues is imperative. To better understand how U.S. Senate members use Twitter (now known as X) to communicate opioid-related issues, we conducted a quantitative content analysis of their opioid-related tweets (N = 697) from January 1 to August 25 2022. Findings reveal a significant political divide regarding how senators characterize the opioid crisis, influencing user engagement on Twitter. Guided by the moral foundation theory, the results suggest that Democratic senators were more likely to employ care/harm or fairness/cheating moral foundations, relative to Republican senators, who used more loyalty/betrayal or authority/subversion. Additionally, Democratic senators framed the opioid crisis as a health or policy issue, relative to Republican senators' immigration/border frame. For inclusion of information sources, Democratic senators included significantly more health sources compared to Republican senators' use of media or law enforcement sources. Issue frame and source type significantly influenced user engagement in the form of likes and retweets. These findings provide both practical and theoretical implications.
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Affiliation(s)
- Anita Silwal
- Department of Communication, University of Kentucky
- Substance Use Priority Research Area, University of Kentucky
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Sauer S. Public stigma against fentanyl overdose decedents in the United States: A conjoint vignette experiment. Soc Sci Med 2024; 350:116937. [PMID: 38710134 DOI: 10.1016/j.socscimed.2024.116937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 04/06/2024] [Accepted: 04/30/2024] [Indexed: 05/08/2024]
Abstract
The United States is facing a drug overdose crisis, and stigma against people who use drugs is a major roadblock to implementing solutions. Despite the public health importance of understanding and mitigating substance use stigma, prior research has focused mainly on perceptions of individuals with substance use disorders and a limited set of demographic traits. This leaves critical gaps in our understanding of stigma against fentanyl overdose decedents, who represent a much broader group, including people who use substances recreationally. This study develops a more robust understanding of these attitudes through an experimental vignette survey fielded to a national sample of American adults (n = 1432). Respondents were shown two fictional fentanyl overdose obituaries where a complex suite of decedent characteristics-including demographic traits and contexts of substance use-were randomly varied in a conjoint design. Respondents then endorsed one of the two decedents for each of several attitudinal outcomes, including blameworthiness and support for various interventions, and justified their choices in an open-ended format. Results indicate that the public assesses victims of fentanyl overdose meritocratically, making judgments based on personal history and life experience rather than traditional race, class, and gender status beliefs. While certainly a signal of progress on some fronts, this meritocratic lens conflicts with the public health model of addressing the overdose crisis and exposes the alarming persistence of explicit stigma against people who use drugs.
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Affiliation(s)
- Sydney Sauer
- Department of Sociology, The Ohio State University, 1885 Neil Ave, Columbus, OH, 43210, United States.
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Moran L, Ondocsin J, Outram S, Ciccarone D, Werb D, Holm N, Arnold EA. How do we understand the value of drug checking as a component of harm reduction services? A qualitative exploration of client and provider perspectives. Harm Reduct J 2024; 21:92. [PMID: 38734643 PMCID: PMC11088080 DOI: 10.1186/s12954-024-01014-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 05/02/2024] [Indexed: 05/13/2024] Open
Abstract
BACKGROUND Mortality related to opioid overdose in the U.S. has risen sharply in the past decade. In California, opioid overdose death rates more than tripled from 2018 to 2021, and deaths from synthetic opioids such as fentanyl increased more than seven times in those three years alone. Heightened attention to this crisis has attracted funding and programming opportunities for prevention and harm reduction interventions. Drug checking services offer people who use drugs the opportunity to test the chemical content of their own supply, but are not widely used in North America. We report on qualitative data from providers and clients of harm reduction and drug checking services, to explore how these services are used, experienced, and considered. METHODS We conducted in-depth semi-structured key informant interviews across two samples of drug checking stakeholders: "clients" (individuals who use drugs and receive harm reduction services) and "providers" (subject matter experts and those providing clinical and harm reduction services to people who use drugs). Provider interviews were conducted via Zoom from June-November, 2022. Client interviews were conducted in person in San Francisco over a one-week period in November 2022. Data were analyzed following the tenets of thematic analysis. RESULTS We found that the value of drug checking includes but extends well beyond overdose prevention. Participants discussed ways that drug checking can fill a regulatory vacuum, serve as a tool of informal market regulation at the community level, and empower public health surveillance systems and clinical response. We present our findings within three key themes: (1) the role of drug checking in overdose prevention; (2) benefits to the overall agency, health, and wellbeing of people who use drugs; and (3) impacts of drug checking services at the community and systems levels. CONCLUSION This study contributes to growing evidence of the effectiveness of drug checking services in mitigating risks associated with substance use, including overdose, through enabling people who use and sell drugs to test their own supply. It further contributes to discussions around the utility of drug checking and harm reduction, in order to inform legislation and funding allocation.
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Affiliation(s)
- Lissa Moran
- Center for AIDS Prevention Studies, Department of Medicine, University of California, San Francisco, CA, 94143, USA.
| | - Jeff Ondocsin
- Center for AIDS Prevention Studies, Department of Medicine, University of California, San Francisco, CA, 94143, USA
- Family & Community Medicine, Department of Medicine, University of California, San Francisco, CA, 94143, USA
| | - Simon Outram
- Center for AIDS Prevention Studies, Department of Medicine, University of California, San Francisco, CA, 94143, USA
| | - Daniel Ciccarone
- Family & Community Medicine, Department of Medicine, University of California, San Francisco, CA, 94143, USA
| | - Daniel Werb
- Centre on Drug Policy Evaluation, St. Michael's Hospital, Toronto, ON, M5B 1W8, Canada
- Division of Infectious Diseases & Global Public Health, UC San Diego School of Medicine, University of California, San Diego, CA, 92093, USA
| | - Nicole Holm
- Family & Community Medicine, Department of Medicine, University of California, San Francisco, CA, 94143, USA
| | - Emily A Arnold
- Center for AIDS Prevention Studies, Department of Medicine, University of California, San Francisco, CA, 94143, USA
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Kennedy-Hendricks A, Ettman CK, Gollust SE, Bandara SN, Abdalla SM, Castrucci BC, Galea S. Experience of Personal Loss Due to Drug Overdose Among US Adults. JAMA HEALTH FORUM 2024; 5:e241262. [PMID: 38819798 PMCID: PMC11143465 DOI: 10.1001/jamahealthforum.2024.1262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 04/09/2024] [Indexed: 06/01/2024] Open
Abstract
Importance Since 1999, over 1 million people have died of a drug overdose in the US. However, little is known about the bereaved, meaning their family, friends, and acquaintances, and their views on the importance of addiction as a policy priority. Objectives To quantify the scope of the drug overdose crisis in terms of personal overdose loss (ie, knowing someone who died of a drug overdose) and to assess the policy implications of this loss. Design, Setting, and Participants This cross-sectional study used data from a nationally representative survey of US adults (age ≥18 years), the fourth wave of the COVID-19 and Life Stressors Impact on Mental Health and Well-Being (CLIMB) study, which was conducted from March to April 2023. Main Outcomes and Measures Respondents reported whether they knew someone who died of a drug overdose and the nature of their relationship with the decedent(s). They also reported their political party affiliation and rated the importance of addiction as a policy issue. Logistic regression models estimated the associations between sociodemographic characteristics and political party affiliation and the probability of experiencing a personal overdose loss and between the experience of overdose loss and the perceived salience of addiction as a policy issue. Survey weights adjusted for sampling design and nonresponse. Results Of the 7802 panelists invited to participate, 2479 completed the survey (31.8% response rate); 153 were excluded because they did not know whether they knew someone who died of a drug overdose, resulting in a final analytic sample of 2326 (51.4% female; mean [SD] age, 48.12 [0.48] years). Of these respondents, 32.0% (95% CI, 28.8%-34.3%) reported any personal overdose loss, translating to 82.7 million US adults. A total of 18.9% (95% CI, 17.1%-20.8%) of all respondents, translating to 48.9 million US adults, reported having a family member or close friend die of drug overdose. Personal overdose loss was more prevalent among groups with lower income (<$30 000: 39.9%; ≥$100 000: 26.0%). The experience of overdose loss did not differ across political party groups (Democrat: 29.0%; Republican: 33.0%; independent or none: 34.2%). Experiencing overdose loss was associated with a greater odds of viewing addiction as an extremely or very important policy issue (adjusted odds ratio, 1.37; 95% CI, 1.09-1.72) after adjustment for sociodemographic and geographic characteristics and political party affiliation. Conclusions and Relevance This cross-sectional study found that 32% of US adults reported knowing someone who died of a drug overdose and that personal overdose loss was associated with greater odds of endorsing addiction as an important policy issue. The findings suggest that mobilization of this group may be an avenue to facilitate greater policy change.
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Affiliation(s)
- Alene Kennedy-Hendricks
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Catherine K. Ettman
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Sarah E. Gollust
- Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis
| | - Sachini N. Bandara
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Salma M. Abdalla
- Department of Epidemiology and Department of Global Health, Boston University School of Public Health, Boston, Massachusetts
| | | | - Sandro Galea
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts
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Andrews CM, Westlake MA, Abraham AJ, Grogan CM, Harris SJ, Jehan S. Medicaid Managed Care Prior Authorization For Buprenorphine Tied To State Partisanship And Health Plan Profit Status, 2018. Health Aff (Millwood) 2024; 43:55-63. [PMID: 38190595 PMCID: PMC11173355 DOI: 10.1377/hlthaff.2023.00288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2024]
Abstract
Buprenorphine is among the most effective drugs for treating opioid use disorder, yet only a quarter of Americans who need it receive it. Requiring prior authorization has been identified as an important barrier to buprenorphine access. However, the practice remains widespread in Medicaid-the largest insurer of Americans with opioid use disorder. In this study, we examined how prior authorization for buprenorphine is related to plan structure and state political environment, using data on all 266 comprehensive Medicaid managed care plans active in 2018. We found substantial variation in prior authorization use across states, with all plans requiring prior authorization in eleven states and no plans requiring it in thirteen other states. We found that for-profit plans and those located in Republican states were more likely to impose prior authorization policies. Our findings suggest that managed care plans' decisions regarding use of prior authorization may be shaped by internal pressures to control costs, as well as by differing partisan stances regarding the need to prevent criminal diversion of buprenorphine.
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Affiliation(s)
- Christina M Andrews
- Christina M. Andrews , University of South Carolina, Columbia, South Carolina
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Clark J, Salins N, Daniel S, Currow DC, Jones L, Pearson M, Bunton R, Mankel J, Braithwaite C, Gilchrist MM, Johnson MJ. Views and experiences of opioid access amongst palliative care providers and public representatives in a low-resource setting: A qualitative interview study. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002401. [PMID: 37733698 PMCID: PMC10513320 DOI: 10.1371/journal.pgph.0002401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 08/24/2023] [Indexed: 09/23/2023]
Abstract
Opioids (e.g. morphine) are affordable, effective interventions for cancer-related pain. However, equity of access to this key medication remains a global challenge, particularly in low- and middle-income countries. We aimed to explore views of palliative care providers and public-representatives about opioid analgesia access in two States in India. We conducted a qualitative study using semi-structured interviews. Transcribed audio-recordings were subjected to thematic analysis using a Framework Approach. Palliative care providers and public-representatives were purposively sampled from services reporting consistent opioid availability and prescribing (≥4kg per annum) from Karnataka and Kerala. Twenty participants (doctors (10), nurses (4), pharmacists (2), service managers (2) and public-representatives (2) were interviewed. Three themes were identified: 1) Attitudes and awareness: opioid treatments are perceived as end-of-life (last days/weeks) interventions; fears of addiction and misunderstanding of pain management goals limit access. 2) Expected and unexpected inequities: patients/carers from lower socioeconomic strata accept doctor recommendations if opioids are affordable, more educated patients/families have reservations about opioids, delay access and perceive expensive medicines as better. Non-palliative care specialist doctors have negative entrenched views and require specialist training. 3) Experiential learning-positive experiences can positively alter attitudes (e.g., participants in Kerala report improved attitudes, awareness and understanding influenced by exposure and community awareness, but experience can also reinforce perceptions as end-of-life care. Entrenched negative views are reinforced by poor experiences while positive experiences improve attitudes. To promote access, opioid prescribing must be needs-based rather than prognosis-based. Addressing the lack of training for non-palliative care workforce would help overcome a major barrier.
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Affiliation(s)
- Joseph Clark
- Wolfson Palliative Care Research Centre, Allam Medical Building, University of Hull, Hull, United Kingdom
| | - Naveen Salins
- Department of Palliative Medicine and Supportive Care, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal, India
| | - Sunitha Daniel
- York and Scarborough Teaching Hospitals NHS Foundation Trust, York, United Kingdom
| | - David C. Currow
- Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, Australia
| | - Lesley Jones
- Hull York Medical School, Allam Medical Building, University of Hull, Hull, United Kingdom
| | - Mark Pearson
- Wolfson Palliative Care Research Centre, Allam Medical Building, University of Hull, Hull, United Kingdom
| | - Robin Bunton
- Wolfson Palliative Care Research Centre, Allam Medical Building, University of Hull, Hull, United Kingdom
| | - Joseph Mankel
- Wolfson Palliative Care Research Centre, Allam Medical Building, University of Hull, Hull, United Kingdom
| | - Christopher Braithwaite
- Wolfson Palliative Care Research Centre, Allam Medical Building, University of Hull, Hull, United Kingdom
| | - Marianne M. Gilchrist
- Wolfson Palliative Care Research Centre, Allam Medical Building, University of Hull, Hull, United Kingdom
| | - Miriam J. Johnson
- Wolfson Palliative Care Research Centre, Allam Medical Building, University of Hull, Hull, United Kingdom
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Willison CE, Singer PM, Creary MS, Vaziri S, Stott J, Greer SL. How do you solve a problem like Maria? The politics of disaster response in Puerto Rico, Florida and Texas. WORLD MEDICAL & HEALTH POLICY 2022; 14:490-506. [PMID: 36247081 PMCID: PMC9545961 DOI: 10.1002/wmh3.476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 07/01/2021] [Accepted: 08/16/2021] [Indexed: 11/10/2022]
Abstract
COVID-19 is not the first, nor the last, public health challenge the US political system has faced. Understanding drivers of governmental responses to public health emergencies is important for policy decision-making, planning, health and social outcomes, and advocacy. We use federal political disaster-aid debates to examine political factors related to variations in outcomes for Puerto Rico, Texas, and Florida after the 2017 hurricane season. Despite the comparable need and unprecedented mortality, Puerto Rico received delayed and substantially less aid. We find bipartisan participation in floor debates over aid to Texas and Florida, but primarily Democrat participation for Puerto Rican aid. Yet, deliberation and participation in the debates were strongly influenced by whether a state or district was at risk of natural disasters. Nearly one-third of all states did not participate in any aid debate. States' local disaster risk levels and political parties' attachments to different racial and ethnic groups may help explain Congressional public health disaster response failures. These lessons are of increasing importance in the face of growing collective action problems around the climate crisis and subsequent emergent threats from natural disasters.
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Affiliation(s)
- Charley E. Willison
- Department of Population Medicine and Diagnostic SciencesCornell UniversityIthacaNew YorkUSA
| | - Phillip M. Singer
- Department of Political ScienceUniversity of UtahSalt Lake CityUtahUSA
| | - Melissa S. Creary
- Department of Health Management and Policy, School of Public HealthUniversity of MichiganAnn ArborMichiganUSA
| | - Soha Vaziri
- Department of Health Management and Policy, School of Public HealthUniversity of MichiganAnn ArborMichiganUSA
| | - Jerry Stott
- Department of Political ScienceUniversity of UtahSalt Lake CityUtahUSA
| | - Scott L. Greer
- Department of Health Management and Policy, School of Public HealthUniversity of MichiganAnn ArborMichiganUSA
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