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Potter JS, Finley EP, King VL, Lanham HJ, Schmidt S, Schneegans S, Rosen KD. Adapting and scaling a single site DEA X-waiver training program to a statewide initiative: Implementing GetWaiveredTX. J Subst Abuse Treat 2021; 137:108688. [DOI: 10.1016/j.jsat.2021.108688] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 11/05/2021] [Accepted: 12/02/2021] [Indexed: 01/10/2023]
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Saloner B, Maclean JC. Specialty Substance Use Disorder Treatment Admissions Steadily Increased In The Four Years After Medicaid Expansion. Health Aff (Millwood) 2021; 39:453-461. [PMID: 32119615 DOI: 10.1377/hlthaff.2019.01428] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The Affordable Care Act's Medicaid expansion provided insurance coverage to many low-income adults with substance use disorders, but it is unclear whether this led to more people receiving treatment. We used the Treatment Episode Data Set and a difference-in-differences approach to compare annual rates of specialty treatment admissions in expansion versus nonexpansion states in the period 2010-17. We found that admissions to treatment steadily increased in the four years after Medicaid expansion, with 36 percent more people entering treatment by the fourth expansion year in expansion states compared to nonexpansion states. Changes were largest for people entering intensive outpatient programs and those seeking medication treatment for opioid use disorder. The share of admissions paid for by Medicaid increased 23 percentage points in expansion states compared to nonexpansion states, largely displacing treatment paid for by state and local governments. The gradual increase in specialty substance use disorder treatment admissions after Medicaid expansion may reflect improving capacity and access to care.
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Affiliation(s)
- Brendan Saloner
- Brendan Saloner ( bsaloner@jhu. edu ) is an associate professor in the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, in Baltimore, Maryland
| | - Johanna Catherine Maclean
- Johanna Catherine Maclean is an associate professor of economics at Temple University, in Philadelphia, Pennsylvania, and a research associate at the National Bureau of Economic Research in Cambridge, Massachusetts
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Bloom DA, Manjunath AK, Kaplan DJ, Egol AJ, Campbell KA, Strauss EJ, Alaia MJ. Reduced opioid prescribing following arthroscopic meniscectomy does not negatively impact patient satisfaction. Knee 2021; 29:216-221. [PMID: 33640620 DOI: 10.1016/j.knee.2021.01.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 01/20/2021] [Accepted: 01/21/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Prior research has demonstrated that physician desire to optimize patient satisfaction is a cause of over-prescription of opioid medications in the healthcare setting. The purpose of this study was to investigate what effect, if any, decreased opioid prescribing following arthroscopic meniscectomy had on Press-Ganey (PG) satisfaction survey scores. METHODS A retrospective review of prospectively-collected data was conducted on patients who underwent arthroscopic meniscectomy between October2014-October2019. Inclusion criteria consisted of complete PG information, no history of trauma, connective tissue disease, or prior knee surgery. Groups were separated based on date of surgery relative to implementation of an institutional opioid reduction policy which occurred on October 1, 2018. Prescriptions were converted to milligram-morphine-equivalents (MME) for direct comparison between opioids. Minimal-Detectable-Change (MDC) was calculated to evaluate clinical significance of any statistically significant findings. RESULTS 554 patients were included in this analysis (452pre-protocol, 102post-protocol). The groups did not differ statistically (p > 0.05) with respect to any patient demographics (age, BMI, sex, prior opioid use, opioid naivete) with the exception of smoking history; 54.4% in the pre-protocol group and 32.4%in the post-protocol group; p < 0.001. Mean discharge dose for the pre-protocol group was 229.3 ± 141MME, and 80.05 ± 82.7MME post-protocol; P < 0.0001. There were no statistically significant differences between pre-and-post-protocol satisfaction with pain control scores; P = 0.15. The differences between satisfaction with pain control did not meet clinical or statistical significance, based on a calculated MDC = 0.368. Among pre-protocol patients, 372(82.3%) gave a "top box" response to the question "degree-to-which-your-pain-was-controlled", compared to 91(89.2%) from the post-protocol group; P = 0.10. CONCLUSION A reduction in opioids prescribed after arthroscopic meniscectomy was not associated with any difference in patient satisfaction with pain management, as measured by the Press-Ganey survey. LOE: 3.
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Knox R. Fourth Amendment Protections of Prescription Drug Monitoring Programs: Patient Privacy in the Opioid Crisis. AMERICAN JOURNAL OF LAW & MEDICINE 2020; 46:375-411. [PMID: 33413012 DOI: 10.1177/0098858820975531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
The opioid crisis is one of the largest public health problems in the history of the United States. Prescription drug monitoring programs ("PDMPs")-state databases containing the records of all prescriptions for controlled substances written in the state-have emerged as a means to track opioid prescribing and use. While PDMPs are typically used as a tool for physicians to inform their prescribing practices, many states also permit law enforcement to access PDMPs when investigating controlled substance distribution, often without prior judicial approval. Such law enforcement use of PDMPs raises serious questions of patient privacy. The Fourth Amendment protects individuals from unreasonable searches and seizures where they have a reasonable expectation of privacy and has been interpreted to require law enforcement have probable cause and a search warrant before infringing upon an individual's reasonable expectation of privacy. Several courts have held that patients have no reasonable expectation of privacy, or a severely diminished expectation of privacy, in their prescription drug records held in PDMPs. As support, courts rely on the third-party doctrine because the information is disclosed to physicians and then held by the state; the highly regulated nature of the prescription drug industry; and the statutory framework of the Controlled Substances Act. Such analysis disregards patients' expectation of privacy in their personal health information, the confidentiality in the physician-patient relationship, and the resulting patient incentives not to seek care. Therefore, this Article argues that law enforcement must have probable cause and a search warrant to access PDMPs because the exceptions to the Fourth Amendment's probable cause and warrant requirements do not apply.
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Affiliation(s)
- Ryan Knox
- Senior Research Fellow, Solomon Center for Health Law and Policy at Yale Law School. J.D., 2019, New York University School of Law; B.S., Health Science, 2016, Boston University. For helpful conversations and comments on earlier drafts of this article and the moot court problem which inspired this article, I would like to thank Nicholas Bagley, Mary Ann Chirba, Ariel Geist, Randy Hertz, Orin Kerr, Sylvia Law, Madhu Swarna, the staff of the N.Y.U. Moot Court Board, the judges and competitors in the 2019 Wendell F. Grimes Moot Court Competition at Boston College Law School, and the staff and anonymous peer reviewer of the American Journal of Law and Medicine. An extra special thank you to Mary Ann Chirba, who supervised my work on the moot court problem that inspired this piece and gave extensive comments on earlier drafts of this article. All opinions and errors are my own
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Fleiz C, Arredondo J, Chavez A, Pacheco L, Segovia LA, Villatoro JA, Cruz SL, Medina-Mora ME, de la Fuente JR. Fentanyl is used in Mexico's northern border: current challenges for drug health policies. Addiction 2020; 115:778-781. [PMID: 31837278 DOI: 10.1111/add.14934] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 11/25/2019] [Accepted: 12/09/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND AIMS Results from a recent study among 750 heroin users in three Mexico's northern border cities revealed an increase in white powder availability (also known as China white) and preference for this product among heroin users, as well as a general perception of increased overdose cases among this population. Here, we questioned whether those findings reflect an increased presence of heroin laced with fentanyl, which is associated with greater risks of overdose but that, until now, has not been described in Mexico. DESIGN We tested fentanyl using highly sensitive test strips in syringe plungers, metal cookers and drug wrappings associated with heroin use. SETTING Three injection sites in Tijuana, Baja California, México. PARTICIPANTS Eighty-nine heroin users who interchanged paraphernalia for new syringes. MEASUREMENTS We tested 59 residues of 'pure' white powder. The rest were white powder with black tar (n = 5) or white powder with crystal meth (n = 9), black tar with crystal meth (n = 1), black tar only (n = 13) and crystal meth only (n = 2). FINDINGS Users believed that they consumed either white powder heroin, white powder heroin with crystal meth, white powder with black tar heroin or black tar heroin only. Analyses revealed that 93% (n = 55) of the 'pure' white powder samples had fentanyl. All (n = 9) the white powder samples mixed with crystal meth and 40% (n = 2) of the white powder with black tar were also laced with fentanyl. CONCLUSIONS In a sample of 89 heroin users in Mexico, most white powder heroin users were unknowingly exposed to fentanyl, with fentanyl detected in 93% of white powder samples.
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Affiliation(s)
- Clara Fleiz
- National Institute of Psychiatry, Ramon de la Fuente Muñiz (INPRM), Mexico City, Mexico.,Members of the Global Studies Seminar, Faculty of Medicine, National Autonomous University of Mexico, (UNAM), Mexico City, Mexico
| | - Jaime Arredondo
- Prevencasa A.C. Tijuana, Tijuana, Mexico.,Drug Policy Program (PPD), Center for Research and Economic Teaching (CIDE), Aguascalientes, Mexico
| | | | | | | | - Jorge A Villatoro
- National Institute of Psychiatry, Ramon de la Fuente Muñiz (INPRM), Mexico City, Mexico.,Members of the Global Studies Seminar, Faculty of Medicine, National Autonomous University of Mexico, (UNAM), Mexico City, Mexico
| | - Silvia L Cruz
- Department of Pharmacobiology, Center for Research and Advanced Studies of the National Polytechnic Institute (Cinvestav), Sede Sur, Ciudad de Mexico, Mexico.,Members of the Global Studies Seminar, Faculty of Medicine, National Autonomous University of Mexico, (UNAM), Mexico City, Mexico
| | - María E Medina-Mora
- National Institute of Psychiatry, Ramon de la Fuente Muñiz (INPRM), Mexico City, Mexico.,Members of the Global Studies Seminar, Faculty of Medicine, National Autonomous University of Mexico, (UNAM), Mexico City, Mexico
| | - Juan R de la Fuente
- Members of the Global Studies Seminar, Faculty of Medicine, National Autonomous University of Mexico, (UNAM), Mexico City, Mexico.,Ambassador of Mexico, United Nations Organization, New York, NY, USA
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Watson DP, Andraka-Christou B, Clarke T, Wiegandt J. Introduction to the special issue on innovative interventions and approaches to expand medication assisted treatment: Seizing research opportunities made available by the opioid STR program. J Subst Abuse Treat 2019; 108:1-3. [PMID: 31668689 DOI: 10.1016/j.jsat.2019.10.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
The 21st Century Cures Act is the most significant piece of U.S. legislation aimed at tackling the opioid epidemic to date. This special issue comprises papers reflecting medication-assisted treatment (MAT)-related research made possible through the Cures Act-authorized State Targeted Response (STR) grant mechanism. Work related to both STR evaluation and original research conducted within the context of STR activities are included in the issue, with topics including community assessments of MAT-related needs, MAT access and linkage, criminal justice-oriented MAT implementation, and adjunctive MAT supports and treatments. All of the research represented this issue is early-stage, with results reflecting data collected primarily within the first of STR's two year funding cycle. While such formative work does have inherent limitations, the gravity of the opioid epidemic requires rapid assessment and dissemination of results to inform the public health response in a manner that will have a timely and meaningful impact.
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Affiliation(s)
- Dennis P Watson
- Center for Dissemination and Implementation Research, Department of Medicine, University of Illinois College of Medicine at Chicago, 818 S. Wolcott Ave., Chicago, IL 60612, United States of America.
| | - Barbara Andraka-Christou
- Department of Health Management and Informatics, University of Central Florida, 4000 Central Florida Boulevard, Orlando, FL 32816, United States of America.
| | - Thomas Clarke
- Substance Abuse and Mental Health Services Administration, 5600 Fishers Lane, Rockville, MD 20866, United States of America.
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