People who inject drugs (PWIDs) are the most stigmatized and marginalized people in the general population (Ahern, Stuber, & Galea, 2007; Birtel, Wood, & Kempa, 2017). This group is not easily accessed by typical means of patient outreach and is one of the most underserved populations for primary care, mental health services, and care for chronic infectious diseases associated with injection drug use including HIV and HCV (Ahern et al., 2007; Dean et al., 2000; Livingston, Milne, Fang, & Amari, 2012; Zeremski et al., 2013). Syringe Service Programs (SSPs) can give public health and social support organizations and agencies access to an otherwise underserved population and give PWID potential access to a constellation of care to address multiple comorbidities associated with injection drug use (Barocas et al., 2014; Pollack, Khoshnood, Blankenship, & Altice, 2002; Zeremski et al., 2013). Additionally, the potential access to primary and secondary care that SSPs may connect PWID to, perceived social support is one of the strongest predictors of well-being and mental health among people with stigmatized conditions including HIV/AIDS, HCV, and PWID (Birtel et al., 2017). Wider adoption of SSPs and bridging of SSP clients to Medication Assisted Treatment providers is a potential tool in combating the current opioid epidemic in Tennessee. The Tennessee Poll by ETSU was conducted between March and April of 2017. The Tennessee Poll is an annual statewide public opinion poll conducted by the Applied Social Research Lab (ASRL). In the Tennessee Poll, questions were asked about attitudes and beliefs associated with SSPs and PWID in Tennessee. In a previous project, the research team, using generational demographic categories used in Pew surveys, looked at attitudes about both illicit and medical use of marijuana. In comparison of generations, Millennials were 15.62 times (95% CI 5.6, 43.56, p < .001) more likely to support recreational marijuana legalization versus the reference category (The Silent Generation or the generation before Baby boomers and sometimes called “The Greatest Generation”) and 3.7 times (95% CI 1.47, 9.3, p

No description available.

This dissertation consists of three essays in health economics. The three chapters focus specifically on prescription drug use and treatment in various national and state settings and evaluate the impact of government policies and interventions on this sector of the health care market. The first two chapters focus on opioid prescribing in the United States. Prescription drug monitoring programs (PDMPs or PMPs)—online systems that health care providers and pharmacists can use to query patient prescription records—are one of the most widely-used state tools in regulating the prescribing and dispensing of opioids. However, the staggered adoption of PDMPs over time has created opportunities for patients to evade monitoring by going to a state that does not have a PDMP. Chapter 1 evaluates how spillovers attributable to policy non-coordination between neighboring states impact the effectiveness of PDMPs. I find that after prescribers gain access to PDMPs, opioid volume and prescription opioid deaths decrease in counties with a PDMP that are insulated from opportunities for evasion. I find a similar effect in counties with a PDMP that are exposed to evasion. This suggests that exposure to evasion through proximity to non-PDMP areas does not significantly attenuate the policy effect. I also find evidence that opioid volume and prescription opioid deaths decrease in counties without a PDMP that are exposed to spillovers from counties with the policy. Illicit opioid deaths are not affected in any counties with a PDMP but decrease in counties without a PDMP that are exposed to spillovers. I discuss the potential mechanisms through which spillovers may operate. Chapter 2, which is joint work with Adam Sacarny, David Powell, Ian Williamson, Weston Merrick, and Mireille Jacobson, evaluates how "nudge" interventions can impact the behavior of clinicians prescribing controlled substances. PMPs aim to reduce inappropriate opioid prescribing but may be underutilized by prescribers. We conduct a randomized clinical trial of 12,000 clinicians in Minnesota to test whether letters to providers can increase PMP use and decrease potentially dangerous opioid co-prescriptions. In this study, we focus on the co-prescribing of opioids and benzodiazepines and the co-prescribing of opioids and gabapentinoids. We find that letters that mention the state's new PMP use mandate increase PMP search rates and the share of clinicians with PMP accounts but have no significant effect on co-prescribing. Letters with only information about the risks of co-prescribing and a list of co-prescribed patients have no detected effect on primary outcomes of interest. We also explore the impact of the letters on additional search and prescribing outcomes. Our results highlight the potential for simple letter-based interventions to encourage engagement with PMPs and facilitate better-informed prescribing of opioids and other medications. Finally, Chapter 3 studies the prescription drug market in Japan, examining how changes in health care prices faced by patients can influence demand. I exploit a feature of the Japanese healthcare system, where an individual's coinsurance rate is determined primarily by their age, to evaluate the impact of a change in patient cost sharing on total prescription drug spending. I contribute to the existing literature by investigating heterogeneous effects by patient sex and drug therapeutic class (focusing on cardiovascular drugs, antibiotics, vitamins, antihistamines, and psychotropic drugs). I find that for the whole sample, price elasticity of spending for prescription drugs is comparable to previous estimates of price elasticity of spending for general medical services. I find no evidence of heterogeneous effects by sex over the whole sample of prescriptions, but I do find statistically significant differences between women and men within therapeutic drug classes. I also conduct exploratory analysis on the effect of changes in patient cost sharing on prescription drug volume. I estimate a price elasticity of demand for prescription drugs that is larger than previous estimates of demand elasticity for general medical services. I also find evidence that physicians do not respond on the intensive margin by prescribing more expensive medications. Although Japanese patients are more likely to be prescribed brand-name drugs, patients using generic medications may be more price sensitive to changes in patient cost sharing.

Opioids have been widely applied in clinics as one of the most potent pain relievers for centuries, but their abuse has deleterious physiological effects beyond addiction. We previously reported that opioids inhibit cell growth and trigger apoptosis in lymphocytes. However, the underlying mechanism by which microglia apoptosis in response to opioids is not yet known. In this study, we show that morphine induces microglia apoptosis and caspase-3 activation in an opioid-receptor dependent manner. Morphine decreased the levels of microglia phosphorylated Akt (p-Akt) and p-GSK-3β (glycogen synthase kinase-3 beta) in an opioid-receptor dependent manner. More interestingly, GSK-3β inhibitor SB216763 significantly increases morphine-induced apoptosis in both BV-2 microglia and mouse primary microglial cells. Moreover, co-treatment of microglia with SB216763 and morphine led to a significant synergistic effect on the level of phospho-p38 mitogen-activated protein kinase (MAPK). In addition, inhibition of p38 MAPK by its specific inhibitor SB203580 significantly inhibited morphine-induced apoptosis and caspase-3 activation. Taken together, our data clearly demonstrates that morphine-induced apoptosis in microglial cells, which is mediated via GSK-3β and p38 MAPK pathways.

Background: Multimodal analgesia in rib fractures (RFs) is designed to maximize pain control while minimizing narcotics. Prior research with intravenous lidocaine (IVL) efficacy produced conflicting results. We hypothesized IVL infusion reduces opioid utilization and pain scores. Methods: A retrospective review of RF patients at an ACS-verified Level I trauma center from April 2018 to 2/2020 was conducted. Patients (pts) stratified as receiving IVL vs no IVL. Initial lidocaine dose: 1 mg/kg/hr with a maximum of 3 mg/kg/hr. Duration of infusion: 48 h. Pain quantified by the Stanford Pain Score system (PS). Bivariate and multivariate analyses of variables were performed on SPSS, version 21 (IBM Corp). Results: 414 pts met inclusion criteria: 254 males and 160 females. The average age for the non-IVL = 67.4 ± 15.2 years vs IVL = 58.3 ± 17.1 years (P <.001). There were no statistically significant differences between groups for ISS, PS for initial 48 h, and ICU length of stay (LOS). There was a difference in morphine equivalents per hour: non-IVL = 1.25 vs IVL = 1.72 (P =.004) and LOS non-IVL = 10.2+/−7.6 vs IVL = 7.82+/−4.94. By analyzing IVL pts in a crossover comparison before and after IVL, there was reduction in opiates: 3.01 vs 1.72 (P <.001) and PS: 7.0 vs 4.9 (P <.001). Stanford Pain Score system reduction in the IVL = 48.3 ± 23.9%, but less effective in narcotic dependency (27 ± 22.9%, P =.035); IVL pts had hospital cost reduction: $82,927 vs $118,202 (P <.01). Discussion: In a crossover analysis, IVL is effective for reduction of PS and opiate use and reduces hospital LOS and costs. Patient age may confound interpretation of results. Our data support IVL use in multimodal pain regimens. Future prospective study is warranted.

Abstract Introduction and Background: Methadone, Buprenorphine and other opioid management therapies are being put into effect to help pregnant women who have abused opioids in the months prior to getting pregnant and continued the abuse during pregnancy. Purpose Statement: The purpose of this research was to determine if opioid maintenance therapies would have lasting effects on infants in their growth development. The population in the studies were derived from women who had or were currently abusing opioids during their pregnancy. The interventions taken were to prescribe women with a specific opioid maintenance treatment and measure the outcome on the infant such as birth weight, head circumference, ability to eat, etc. Literature Review: The East Tennessee State University Sherrod Library database was used to search for articles pertaining to the research. The method includes searching for key terms such as opioids on fetal development and ways to improve fetal development with opioid addiction within the years of 2017 to 2022 from peer reviewed journal articles. Findings: The researchers in each study were able to come to a consensus that there were no more effects put into fetal development with the opioid therapy and the subjects that were not given therapy during pregnancy. Conclusion: In the end, some studies showed minor effects that infants would have with getting opioid maintenance therapy in utero but concluded that infants would not experience any more damage to their development by receiving the treatment over infants who did not receive the treatment in utero.

No description available.

Gambling disorder is today a common disorder causing lives to shatter. As this disorder activates the reward system and increases the need of dopamine, recovering from gamling disorder can be hard. Research has shown that gambling addiction appears to have similarities to substance abuse, but no substance has been named. Therefore, this systematic review discusses similarities and differences between gambling and opioid addiction. The aim is to compare behavior and neurological correlates of gambling and opioid addiction tocreate a better understanding of the relationship between these addictions and hopefully help improve treatments. My expectation was that I would find behavioral and neurological similarities between opioid and gambling addicts. To investigate this, I conducted a systematic search across databases. I compared six studies which all used a task to investigate decision-making ability and brain-scanning to investigate neural correlates. Both gambling and opioid addicts show decreased activation in the orbitofrontal cortex, which plays a central role in decision-making. Regarding task performance, some studies showed addicts to perform worse than controls, suggesting that addicts show an impaired decision-making ability compared to controls. This systematic review contributes to the literature within addiction, but to draw a conclusion that gambling and opioid addicts suffer from similar decision-making impairment further research is needed.

The historic tobacco Master Settlement Agreement (MSA) between 46 State Attorneys General and the tobacco industry in 1999 had a range of consequences. It resulted in the closure of tobacco industry policy groups that undermined public health, sharply reduced tobacco marketing using cartoon characters (eg, Joe Camel) and paid product placement in television, film and other media, and created a new nonprofit foundation whose primary goal was to educate youth and prevent them from initiating tobacco use. It also resulted in more than $206 billion in resources being allocated to states, subject to appropriation by state legislators and governors. This enabled states to recoup the cost of medical and other treatment expenditures for tobacco‐related illness.1 However, by 2018, only 2.6% of the $206 billion in settlement and tobacco state taxes had been used for tobacco‐related harm mitigation or prevention.

The Covid-19 pandemic has complicated efforts to address the US’s opioid crisis with a comprehensive, multi-part federal effort that combines primary medical care, essential support services, outreach to persons who misuse substances, patient engagement, and access to medications for opioid use disorder (OUD). This webinar will focus on how the pandemic is impacting efforts to address the opioid crisis. The panelists will also discuss some of the recommendations of the ASPPH Task Force on Public Health Approaches to the Opioid Crisis and how the pandemic might impact the panel’s recommendations, including its recommendation that a multi-site, multi-institutional collaborative evaluation structure be created that can leverage the strengths of different universities and agencies toward an effective, coordinated approach.