Comparative Analysis of State Level Health Policy Support for Opioid Abuse Mitigation in Rural America

2021 ◽  
pp. 137-161
Author(s):  
Carrie Shaver ◽  
James Johnson ◽  
Richard Greenhill ◽  
Sudha Nadimidla
Keyword(s):  
Public Health ◽  
Health Policy ◽  
Comparative Analysis ◽  
Best Practice ◽  
Financial Burden ◽  
State Level ◽  
Opioid Use Disorder ◽  
Policy Support ◽  
Rural America ◽  
Opioid Use

In rural America, opioid use disorder (OUD) continues to adversely impacted familial, public, and economic systems, creating extraordinary societal and financial burden. This comparative analysis of state-level public health policy and practices in rural opioid use abatement promotes the development and implementation of contextualized evidence-based comprehensive policy initiatives. Policy analysis across select highly affected states (Indiana, Kansas, Kentucky, and West Virginia) and exemplar OUD policy response states (Colorado, Massachusetts, Ohio, and Vermont) was performed using a systematic review of literature, legislation, plans, and policies. Findings included close alignment between states’ OUD policies and public health best practice standards; minimized differences between exemplar and highly affected states policy responses; and resource driven gaps in opioid epidemic legislation, regulation, guidelines, strategic plans, and initiatives. Furthermore, it is advocated that public and private stakeholders committed to health equity must seek reductions in opioid related disease and mortality through increased resource allocation.

scholarly journals Demystifying the Opioid Trade in Anonymous Markets and Forums (Preprint)

2020 ◽  
Author(s):  
Zhengyi Li ◽  
Xiangyu Du ◽  
Xiaojing Liao ◽  
Xiaoqian Jiang ◽  
Tiffany Champagne-Langabeer
Keyword(s):  
Public Health ◽  
Supply Chain ◽  
Large Scale ◽  
Supply And Demand ◽  
Opioid Use Disorder ◽  
Public Health Issue ◽  
Opioid Use ◽  
Longitudinal Measurement ◽  
Online Marketplaces ◽  
Trading Activities

BACKGROUND Opioid use disorder presents a public health issue afflicting millions across the globe. There is a pressing need to understand the opioid supply chain to gain new insights into the mitigation of opioid use and effectively combat the opioid crisis. The role of anonymous online marketplaces and forums that resemble eBay or Amazon, where anyone can post, browse, and purchase opioid commodities, has become more and more important in opioid trading. Therefore, a greater understanding of anonymous markets and forums may enable public health officials and other stakeholders to comprehend the scope of the crisis. OBJECTIVE The objective of this work is to profile the opioid supply chain in anonymous markets and forums via a large-scale, longitudinal measurement study on anonymous market listings and posts. Toward this, we propose a series of techniques to collect data, to identify opioid jargon terms used in the anonymous marketplaces and forums, and to profile the opioid commodities, suppliers, and transactions. METHODS We first conducted a whole-site crawl of anonymous online marketplaces and forums to solicit data. Then, we developed a suite of opioid domain-specific text mining techniques (e.g., opioid jargon detection, opioid trading information retrieval) to recognize information relevant to opioid trading activities (e.g., commodities, price, shipping information, suppliers, etc.). After that, we conducted a comprehensive, large-scale, longitudinal study to demystify opioid trading activities in anonymous markets and forums. RESULTS A total of 248,359 listings from 10 anonymous online marketplaces and 1,138,961 traces (i.e., threads of posts) from 6 underground forums were collected. Among them, we identified 28,106 opioid product listings and 13,508 opioid-related promotional and review forum traces from 5147 unique opioid suppliers’ IDs and 2778 unique opioid buyers’ IDs. Our study characterized opioid suppliers (e.g., activeness and cross-market activities), commodities (e.g., popular items and their evolution), and transactions (e.g., origins and shipping destination) in anonymous marketplaces and forums, which enabled a greater understanding of the underground trading activities involved in international opioid supply and demand. CONCLUSIONS The results provide insight into opioid trading in the anonymous markets and forums, and may prove an effective mitigation data point for illuminating the opioid supply chain.

Legislative discrepancies: an analysis of Missouri’s current human trafficking laws and the need to improve its legal protection of victims

2020 ◽  
Vol 13 (2) ◽  
pp. 143-158
Author(s):  
Rachel Kappler ◽  
Arduizur Carli Richie-Zavaleta
Keyword(s):  
Public Health ◽  
Human Rights ◽  
Best Practice ◽  
Legal Protection ◽  
State Level ◽  
The State ◽  
Safe Harbor ◽  
Content Type ◽  
The Usa

Purpose Human trafficking (HT) is a local, national and international problem with a range of human rights, public health and policy implications. Victims of HT face atrocious abuses that negatively impact their health outcomes. When a state lacks protective laws, such as Safe Harbor laws, victims of HT tend to be seen as criminals. This paper aims to highlight the legal present gaps within Missouri’s anti-trafficking legislation and delineates recommendations for the legal protection of victims of HT and betterment of services needed for their reintegration and healing. Design/methodology/approach This case-study is based on a policy analysis of current Missouri’s HT laws. This analysis was conducted through examining current rankings systems created by nationally and internationally recognized non-governmental organizations as well as governmental reports. Additionally, other state’s best practice and law passage of Safe Harbor legislations were examined. The recommendations were based on human rights and public health frameworks. Findings Missouri is a state that has yet to upgrade its laws lately to reflect Safe Harbor laws. Constant upgrades and evaluations of current efforts are necessary to protect and address HT at the state and local levels. Public health and human rights principles can assist in the upgrading of current laws as well as other states’ best-practice and integration of protective legislation and diversion programs to both youth and adult victims of HT. Research limitations/implications Laws are continually being updated at the state level; therefore, there might be some upgrades that have taken place after the analysis of this case study was conducted. Also, the findings and recommendations of this case study are limited to countries that are similar to the USA in terms of the state-level autonomy to pass laws independently from federal law. Practical implications If Safe Harbor laws are well designed, they have greater potential to protect, support and assist victims of HT in their process from victimization into survivorship as well as to paving the way for societal reintegration. The creation and enforcement of Safe Harbor laws is a way to ensure the decriminalization process. Additionally, this legal protection also ensures that the universal human rights of victims are protected. Consequently, these legal processes and updates could assist in creating healthier communities in the long run in the USA and around the world. Social implications From a public health and human rights perspectives, communities in the USA and around the world cannot provide complete protection to victims of HT until their anti-trafficking laws reflect Safe Harbor laws. Originality/value This case study, to the best of the authors’ knowledge, is a unique analysis that dismantles the discrepancies of Missouri’s current HT laws. This work is valuable to those who create policies at the state level and advocate for the protection of victims and anti-trafficking efforts.

scholarly journals Social Stigma Toward Persons With Prescription Opioid Use Disorder: Associations With Public Support for Punitive and Public Health–Oriented Policies

2017 ◽  
Vol 68 (5) ◽  
pp. 462-469 ◽  
Author(s):  
Alene Kennedy-Hendricks ◽  
Colleen L. Barry ◽  
Sarah E. Gollust ◽  
Margaret E. Ensminger ◽  
Margaret S. Chisolm ◽  
...  
Keyword(s):  
Public Health ◽  
Social Stigma ◽  
Public Support ◽  
Opioid Use Disorder ◽  
Prescription Opioid ◽  
Opioid Use ◽  
Prescription Opioid Use

scholarly journals Opioids and Infectious Diseases: A Converging Public Health Crisis

2019 ◽  
Vol 220 (3) ◽  
pp. 346-349 ◽  
Author(s):  
Tara A Schwetz ◽  
Thomas Calder ◽  
Elana Rosenthal ◽  
Sarah Kattakuzhy ◽  
Anthony S Fauci
Keyword(s):  
Public Health ◽  
Infectious Diseases ◽  
Opioid Use Disorder ◽  
Soft Tissue Infections ◽  
Opioid Use ◽  
Therapeutic Approaches ◽  
Predisposing Factor ◽  
Health Crisis ◽  
Public Health Crisis ◽  
Immunodeficiency Virus

Abstract A converging public health crisis is emerging because the opioid epidemic is fueling a surge in infectious diseases, such as human immunodeficiency virus infection with or without AIDS, the viral hepatitides, infective endocarditis, and skin and soft-tissue infections. An integrated strategy is needed to tailor preventive and therapeutic approaches toward infectious diseases in people who misuse and/or are addicted to opioids and to concurrently address the underlying predisposing factor for the infections—opioid use disorder. This commentary highlights the unique and complementary roles that the infectious diseases and substance use disorder communities can play in addressing this crisis of dual public health concerns.

scholarly journals Project MIMIC (Maximizing Implementation of Motivational Incentives in Clinics): A cluster-randomized type 3 hybrid effectiveness-implementation trial

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Sara J. Becker ◽  
Cara M. Murphy ◽  
Bryan Hartzler ◽  
Carla J. Rash ◽  
Tim Janssen ◽  
...  
Keyword(s):  
Public Health ◽  
Patient Outcomes ◽  
The United States ◽  
Opioid Use Disorder ◽  
Treatment Programs ◽  
Opioid Use ◽  
Opioid Treatment ◽  
Implementation Outcomes ◽  
Cluster Randomized ◽  
Type 3

Abstract Background Opioid-related overdoses and harms have been declared a public health emergency in the United States, highlighting an urgent need to implement evidence-based treatments. Contingency management (CM) is one of the most effective behavioral interventions when delivered in combination with medication for opioid use disorder, but its implementation in opioid treatment programs is woefully limited. Project MIMIC (Maximizing Implementation of Motivational Incentives in Clinics) was funded by the National Institute on Drug Abuse to identify effective strategies for helping opioid treatment programs improve CM implementation as an adjunct to medication. Specific aims will test the impact of two different strategies on implementation outcomes (primary aim) and patient outcomes (secondary aims), as well as test putative mediators of implementation effectiveness (exploratory aim). Methods A 3-cohort, cluster-randomized, type 3 hybrid design is used with the opioid treatment programs as the unit of randomization. Thirty programs are randomized to one of two conditions. The control condition is the Addiction Technology Transfer Center (ATTC) Network implementation strategy, which consists of three core approaches: didactic training, performance feedback, and on-going consultation. The experimental condition is an enhanced ATTC strategy, with the same core ATTC elements plus two additional theory-driven elements. The two additional elements are Pay-for-Performance, which aims to increase implementing staff’s extrinsic motivations, and Implementation & Sustainment Facilitation, which targets staff’s intrinsic motivations. Data will be collected using a novel, CM Tracker tool to document CM session delivery, session audio recordings, provider surveys, and patient surveys. Implementation outcomes include CM Exposure (number of CM sessions delivered per patient), CM Skill (ratings of CM fidelity), and CM Sustainment (number of patients receiving CM after removal of support). Patient outcomes include self-reported opioid abstinence and opioid-related problems (both assessed at 3- and 6-months post-baseline). Discussion There is urgent public health need to improve the implementation of CM as an adjunct to medication for opioid use disorder. Consistent with its hybrid type 3 design, Project MIMIC is advancing implementation science by comparing impacts of these two multifaceted strategies on both implementation and patient outcomes, and by examining the extent to which the impacts of those strategies can be explained by putative mediators. Trial registration: This clinical trial has been registered with clinicaltrials.gov (NCT03931174). Registered April 30, 2019. https://clinicaltrials.gov/ct2/show/NCT03931174?term=project+mimic&draw=2&rank=1

scholarly journals The effects of the first and second wave of COVID-19 pandemic on public health

2020 ◽  
Author(s):  
Mario Coccia
Keyword(s):  
Public Health ◽  
Health Policy ◽  
Crisis Management ◽  
Best Practice ◽  
Summer Season ◽  
Health Policies ◽  
Negative Effects ◽  
Maximum Capacity ◽  
Negative Effect ◽  
Second Wave

Abstract One of the current problems in the presence of COVID-19 pandemic crisis is to analyze the effects of the second wave on public health to design appropriate strategies to reduce negative effects in society. The study here analyzes first and second wave of COVID-19 pandemic in Italy because is one of European countries to experience a rapid increase in confirmed cases and deaths. Results reveal that the first wave of COVID-19 pandemic in Italy had a high negative effect on public health from February to May 2020 that declined with the approaching of summer season and with the health policy of lockdown and quarantine; instead, second wave of the COVID-19 pandemic, from October 2020, has increasing confirmed cases but admission to ICUs is, to date, below maximum capacity and total deaths have a lower level than first wave. This study can support best practice of crisis management to design effective health policies to constrain current and future waves of the COVID-19 pandemic and epidemics of similar viral agents.

scholarly journals Development and validation of the Capacity to Treat Chronic Pain and Opioid Use Disorder (CAP-POD) questionnaire

2020 ◽  
Vol 1 ◽  
pp. 263348952094885
Author(s):  
Allyson L Varley ◽  
Burel R Goodin ◽  
Heith Copes ◽  
Stefan G Kertesz ◽  
Kevin Fontaine ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Best Practice ◽  
Primary Care Providers ◽  
Opioid Use Disorder ◽  
Care Providers ◽  
Opioid Use ◽  
High Quality Research ◽  
Practice Recommendations ◽  
Factors Influencing ◽  
Item Questionnaire

Background: Patients with co-occurring chronic pain and opioid use disorder (OUD) have unique needs that may present challenges for clinicians and health care systems. Primary care providers’ (PCPs) capacity to deliver high quality, research-informed care for this population is unknown. The objective of this study was to develop and test a questionnaire of factors influencing PCP capacity to treat co-occurring chronic pain and OUD. Methods: Capacity to Treat Co-Occurring Chronic Pain and Opioid Use Disorder (CAP-POD) questionnaire items were developed over a 2-year process including literature review, semi-structured interviews, and expert panel review. In 2018, a national sample of 509 PCPs was recruited through email to complete a questionnaire including the initial 44-item draft CAP-POD questionnaire. CAP-POD items were analyzed for dimensionality, inter-item reliability, and construct validity. Results: Principal component analysis resulted in a 22-item questionnaire. Twelve more items were removed for parsimony, resulting in a final 10-item questionnaire with the following 4 scales: (1) Motivation to Treat patients with chronic pain and OUD (α = .87), (2) Trust in Evidence (α = .87), (3) Assessing Risk (α = .82), and (4) Patient Access to therapies (α = .79). These scales were associated with evidence-based practice attitudes, knowledge of pain management, and self-reported behavioral adherence to best practice recommendations. Conclusion: We developed a brief, 10-item questionnaire that assesses factors influencing the capacity of PCPs to implement best practice recommendations for the treatment of co-occurring chronic pain and OUD. The questionnaire demonstrated good reliability and initial evidence of validity, and may prove useful in future research as well as clinical settings. Plain language abstract Patients with co-occurring chronic pain and opioid use disorder (OUD) have unique needs that may present challenges for clinicians and health care systems. Primary care providers’ (PCPs) ability to deliver high quality, research-informed care for this population is unknown. There are no validated instruments to assess factors influencing PCP capacity to implement best practices for treating these patients. The objective of this study was to develop and test a questionnaire of factors influencing PCP capacity to treat co-occurring chronic pain and OUD. We recruited 509 PCPs to participate in an online questionnaire that included 44 potential items that assess PCP capacity. Analyses resulted in a 10-item questionnaire that assesses factors influencing capacity to implement best practice recommendations for the treatment of co-occurring chronic pain and OUD. PCPs reported moderately high confidence in the strength and quality of evidence for best practices, and in their ability to identify patients at risk. However, PCPs reported low motivation to treat co-occurring chronic pain and OUD, and perceived patients’ access to relevant services as suboptimal, highlighting two areas that should be targeted with tailored implementation strategies. The 10-item Capacity to Treat Chronic Pain and Opioid Use Disorder (CAP-POD) questionnaire can be used for two purposes: (1) to assess factors influencing PCP capacity before implementation and identify areas that may require improvement for implementation and (2) to evaluate implementation interventions aimed at increasing PCP capacity to treat this population.

scholarly journals Alternatives to Arrest for Illicit Opioid Use: A Joint Criminal Justice and Healthcare Treatment Collaboration

2020 ◽  
Vol 14 ◽  
pp. 117822182095339
Author(s):  
Andrea J Yatsco ◽  
Rachel D Garza ◽  
Tiffany Champagne-Langabeer ◽  
James R Langabeer
Keyword(s):  
Public Health ◽  
Criminal Justice ◽  
Law Enforcement ◽  
Opioid Use Disorder ◽  
Opioid Use ◽  
Health Crisis ◽  
Public Health Crisis ◽  
The Us ◽  
History Of ◽  
Illicit Opioid Use

Opioid overdoses continue to be a leading cause of death in the US. This public health crisis warrants innovative responses to help prevent fatal overdose. There is continued advocacy for collaborations between public health partners to create joint responses. The high correlation between persons with opioid use disorder who have a history of involvement in the criminal justice system is widely recognized, and allows for treatment intervention opportunities. Law enforcement-led treatment initiatives are still relatively new, with a few sparse early programs emerging almost a decade ago and only gaining popularity in the past few years. A lack of published methodologies creates a gap in the knowledge of applied programs that are effective and can be duplicated. This article seeks to outline an interagency relationship between police and healthcare that illustrates arrest is not the only option that law enforcement may utilize when encountering persons who use illicit substances. Program methods of a joint initiative between law enforcement and healthcare in a large, metropolitan area will be reviewed, supplemented with law enforcement overdose data and statistics on law enforcement treatment referrals.

CommunityStat: A Public Health Intervention to Reduce Opioid Overdose Deaths in Burlington, Vermont, 2017–2020

2021 ◽  
pp. 009145092110521
Author(s):  
Brandon del Pozo
Keyword(s):  
Public Health ◽  
New York ◽  
Performance Metrics ◽  
Public Health Intervention ◽  
Police Department ◽  
Opioid Use Disorder ◽  
Health Staff ◽  
Opioid Overdose ◽  
Opioid Use ◽  
Overdose Deaths

From 2017 to early 2020, the US city of Burlington, Vermont led a county-wide effort to reduce opioid overdose deaths by concentrating on the widespread, low-barrier distribution of medications for opioid use disorder. As a small city without a public health staff, the initiative was led out of the police department—with an understanding that it would not be enforcement-oriented—and centered on a local adaptation of CompStat, a management and accountability program developed by the New York City Police Department that has been cited as both yielding improvements in public safety and overemphasizing counterproductive police performance metrics if not carefully directed. The initiative was instrumental to the implementation of several novel interventions: low-threshold buprenorphine prescribing at the city’s syringe service program, induction into buprenorphine-based treatment at the local hospital emergency department, elimination of the regional waiting list for medications for opioid use disorder (MOUD), and the de-facto decriminalization of diverted buprenorphine by the chief of police and county prosecutor. An effort by local legislators resulted in a state law requiring all inmates with opioid use disorder be provided with MOUD as well. By the end of 2018, these interventions were collectively associated with a 50% (17 vs. 34) reduction in the county’s fatal overdose deaths, while deaths increased 20% in the remainder of Vermont. The reduction was sustained through the end of 2019. This article describes the effort undertaken by officials in Burlington to implement these interventions. It provides an example that other municipalities can use to take an evidence-based approach to reducing opioid deaths, provided stakeholders assent to sustained collaboration in the furtherance of a commitment to save lives. In doing so, it highlights that police-led public health interventions are the exception, and addressing the overdose crisis will require reform that shifts away from criminalization as a community’s default framework for substance use.

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