Publications by authors named "Corey S Davis"

86 Publications

Good Samaritan laws and overdose mortality in the United States in the fentanyl era.

Int J Drug Policy 2021 Jun 3;97:103294. Epub 2021 Jun 3.

New York University Grossman School of Medicine, Department of Population Health, 180 Madison Avenue, 4th Floor, New York, NY 10016, United States.

Background: As of July 2018, 45 United States (US) states and the District of Columbia have enacted an overdose Good Samaritan law (GSL). These laws, which provide limited criminal immunity to individuals who request assistance during an overdose, may be of importance in the current wave of the overdose epidemic, which is driven primarily by illicit opioids including heroin and fentanyl. There are substantial differences in the structures of states' GSL laws which may impact their effectiveness. This study compared GSLs which have legal provisions protecting from arrest and laws which have more limited protections.

Methods: Using national county-level overdose mortality data from 3109 US counties, we examined the association of enactment of GSLs with protection from arrest and GSLs with more limited protections with subsequent overdose mortality between 2013 and 2018. Since GSLs are often enacted in conjunction with Naloxone Access Laws (NAL), we examined the effect of GSLs separately and in conjunction with NAL. We conducted these analyses using hierarchical Bayesian spatiotemporal Poisson models.

Results: GSLs with protections against arrest enactment in conjunction with a NAL were associated with 7% lower rates of all overdose deaths (rate ratio (RR): 0.93% Credible Interval (CI): 0.89-0.97), 10% lower rates in opioid overdose deaths (RR: 0.90; CI: 0.85-0.95) and 11% lower rates of heroin/synthetic overdose mortality (RR: 0.89; CI: 0.82-0.96) two years after enactment, compared to rates in states without these laws. Significant reductions in overdose mortality were not seen for GSLs with protections for charge or prosecution.

Conclusion: GSLs with more expansive legal protections combined with a NAL, were associated with lower rates of overdose deaths, although these risk reductions take time to manifest. Policy makers should consider enacting and implementing more expansive GSLs with arrest protections to increase the likelihood people will contact emergency services in the event of an overdose.
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http://dx.doi.org/10.1016/j.drugpo.2021.103294DOI Listing
June 2021

Expanding Mail-Based Distribution of Drug-Related Harm Reduction Supplies Amid COVID-19 and Beyond.

Am J Public Health 2021 06;111(6):1013-1017

Brian S. Barnett is with the Department of Psychiatry and Psychology, Center for Behavioral Health, Neurological Institute, Cleveland Clinic, Cleveland, OH. Sarah E. Wakeman is with the Division of General Internal Medicine, Massachusetts General Hospital, and the Department of Medicine, Harvard Medical School, Boston. Corey S. Davis is with The Network for Public Health Law, Los Angeles, CA. Jamie Favaro is with NEXT Distro, New York, NY. Josiah D. Rich is with the Departments of Medicine and Epidemiology, Brown University, and the Center for Health and Justice Transformation, The Miriam Hospital, Providence, RI.

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http://dx.doi.org/10.2105/AJPH.2021.306228DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8101586PMC
June 2021

Legal Authority for Emergency Medical Services to Increase Access to Buprenorphine Treatment for Opioid Use Disorder.

Ann Emerg Med 2021 Mar 26. Epub 2021 Mar 26.

Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, RI.

Treatment with buprenorphine significantly reduces both all-cause and overdose mortality among individuals with opioid use disorder. Offering buprenorphine treatment to individuals who experience a nonfatal opioid overdose represents an opportunity to reduce opioid overdose fatalities. Although some emergency departments (EDs) initiate buprenorphine treatment, many individuals who experience an overdose either refuse transport to the ED or are transported to an ED that does not offer buprenorphine. Emergency medical services (EMS) professionals can help address this treatment gap. In this Concepts article, we describe the federal legal landscape that governs the ability of EMS professionals to administer buprenorphine treatment, and discuss state and local regulatory considerations relevant to this promising and emerging practice.
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http://dx.doi.org/10.1016/j.annemergmed.2021.01.017DOI Listing
March 2021

Permanent Methadone Treatment Reform Needed to Combat the Opioid Crisis and Structural Racism.

J Addict Med 2021 Mar 19. Epub 2021 Mar 19.

Grayken Center for Addiction, Boston Medical Center, Boston, MA (AP, ZW); Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine and Boston Medical Center, Boston, MA (AP, ZW); Network for Public Health Law, Los Angeles, CA (CSD).

Since early 2020 COVID-19 has swept across the United States, exposing shortcomings in the current healthcare delivery system. Although some interim efforts have been made to mitigate the spread of infection and maintain access to treatment for opioid use disorder, more permanent changes are needed to combat the ongoing opioid crisis. In this commentary, we describe the regulatory barriers to methadone maintenance treatment that disproportionately impact communities of color. We then discuss strategies supporting more equitable access to this proven treatment for opioid use disorder.
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http://dx.doi.org/10.1097/ADM.0000000000000841DOI Listing
March 2021

Harm Reduction, By Mail: the Next Step in Promoting the Health of People Who Use Drugs.

J Urban Health 2021 Mar 12. Epub 2021 Mar 12.

Division of General Internal Medicine, Montefiore Medical Center, 3300 Kossuth Ave., Bronx, NY, 10467, USA.

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http://dx.doi.org/10.1007/s11524-021-00534-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7953942PMC
March 2021

Considering the Potential Benefits of Over-the-Counter Naloxone.

Integr Pharm Res Pract 2021 15;10:13-21. Epub 2021 Feb 15.

Harm Reduction Legal Project, Los Angeles, CA, USA.

Since 1999, annual opioid-related overdose (ORO) mortality has increased more than six-fold. In response to this crisis, the US Department of Health and Human Services outlined a 5-point strategy to reduce ORO mortality which included the widespread distribution of naloxone, an opioid antagonist that can rapidly reverse an opioid overdose. Increased distribution has been facilitated by the implementation of naloxone access laws in each US state aimed at increasing community access to naloxone. While these laws differ from state-to-state, most contain mechanisms to enable pharmacists to dispense naloxone without a patient-specific prescription. These laws have enhanced community naloxone distribution, both from pharmacies and overdose education and naloxone distribution programs, and produced positive effects on ORO mortality. However, a growing body of evidence has revealed that significant barriers to naloxone access from pharmacies remain, and annual ORO deaths have continued to climb. Given these concerns, there has been a push among some clinicians and policymakers for the US Food and Drug Administration to re-classify naloxone as an over-the-counter (OTC) medication as a means to further increase its accessibility. If an OTC transition occurs, educational outreach and funding for clinical innovations will continue to be crucial given the important role of health professionals in recommending naloxone to people at risk for experiencing or witnessing an ORO. Recognizing the severity of the ORO public health crisis, we believe transitioning formulations of naloxone approved for layperson use to OTC status would result in a net benefit through increased access. However, such a change should be combined with measures to ensure affordability.
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http://dx.doi.org/10.2147/IPRP.S244709DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7894851PMC
February 2021

The Purdue Pharma Opioid Settlement - Accountability, or Just the Cost of Doing Business?

Authors:
Corey S Davis

N Engl J Med 2021 Jan 9;384(2):97-99. Epub 2021 Jan 9.

From the Network for Public Health Law, Los Angeles.

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http://dx.doi.org/10.1056/NEJMp2033382DOI Listing
January 2021

Laws limiting prescribing and dispensing of opioids in the United States, 1989-2019.

Addiction 2021 Jul 18;116(7):1817-1827. Epub 2021 Jan 18.

Network for Public Health Law, Los Angeles, CA, USA.

Background And Aims: Opioid overdose is a public health emergency in the United States. In an attempt to reduce potentially inappropriate opioid prescribing, many US states have adopted legal restrictions on the ability of medical professionals to prescribe or dispense opioids for pain. This review describes the major elements of relevant US state laws and the ways in which they have changed over time.

Methods: Systematic legal review in which two trained legal researchers collected and reviewed all US state laws that limit the amount or duration of opioids that medical professionals may prescribe or dispense for pain. These laws were then coded on a set of pre-selected measures, including when the law was enacted, dosage and duration limits imposed, circumstances in which the restrictions do not apply and whether additional requirements or restrictions apply to prescriptions issued to minors.

Results: The number of US states with opioid limitation laws increased from 10 in 2016 to 39 by the end of 2019. The provisions of these laws vary between states and have shifted within states over time. At the end of 2019 the modal duration limit was 7 days, with a range of 3 to 31. Fourteen states imposed limits on the dosage of opioids that can be prescribed, ranging from 30 morphine milligram equivalents (MME) to a 120 MME daily maximum. In 16 states, different limits apply to prescriptions issued to minors.

Conclusions: The number of US states with opioid limitation laws nearly quadrupled between 2016 and 2019, with a great amount of heterogeneity between state restrictions and changes over time.
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http://dx.doi.org/10.1111/add.15359DOI Listing
July 2021

Yes, You Need a Lawyer: Integrating Legal Epidemiology Into Health Research.

Public Health Rep 2020 Nov/Dec;135(6):856-858. Epub 2020 Sep 15.

6558 Center for Public Health Law Research, Temple University Beasley School of Law, Philadelphia, PA, USA.

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http://dx.doi.org/10.1177/0033354920954516DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7649980PMC
January 2021

Continuing increased access to buprenorphine in the United States via telemedicine after COVID-19.

Int J Drug Policy 2020 Aug 15:102905. Epub 2020 Aug 15.

Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, RI, USA; Overdose Prevention Program, Rhode Island Department of Public Health, Providence, RI, USA.

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http://dx.doi.org/10.1016/j.drugpo.2020.102905DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7428767PMC
August 2020

Gene flow and climate-associated genetic variation in a vagile habitat specialist.

Mol Ecol 2020 10 12;29(20):3889-3906. Epub 2020 Sep 12.

Department of Biological Sciences, University of Alberta, Edmonton, Alberta, Canada.

Previous work in landscape genetics suggests that geographic isolation is of greater importance to genetic divergence than variation in environmental conditions. This is intuitive when configurations of suitable habitat are a dominant factor limiting dispersal and gene flow, but has not been thoroughly examined for habitat specialists with strong dispersal capability. Here, we evaluate the effects of geographic and environmental isolation on genetic divergence for a vagile invertebrate with high habitat specificity and a discrete dispersal life stage: Dod's Old World swallowtail butterfly, Papilio machaon dodi. In Canada, P. m. dodi are generally restricted to eroding habitat along major river valleys where their larval host plant occurs. A series of causal and linear mixed effects models indicate that divergence of genome-wide single nucleotide polymorphisms is best explained by a combination of environmental isolation (variation in summer temperatures) and geographic isolation (Euclidean distance). Interestingly, least-cost path and circuit distances through a resistance surface parameterized as the inverse of habitat suitability were not supported. This suggests that, although habitat associations of many butterflies are specific due to reproductive requirements, habitat suitability and landscape permeability are not equivalent concepts due to considerable adult vagility. We infer that divergent selection related to variation in summer temperatures has produced two genetic clusters within P. m. dodi, differing in voltinism and diapause propensity. Within the next century, temperatures are predicted to rise by amounts greater than the present-day difference between regions of the genetic clusters, potentially affecting the persistence of the northern cluster under continued climate change.
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http://dx.doi.org/10.1111/mec.15604DOI Listing
October 2020

Association of Pregnancy and Insurance Status With Treatment Access for Opioid Use Disorder.

JAMA Netw Open 2020 08 3;3(8):e2013456. Epub 2020 Aug 3.

Vanderbilt Center for Child Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee.

Importance: Medications for opioid use disorder, including buprenorphine hydrochloride and methadone hydrochloride, are highly effective at improving outcomes for individuals with the disorder. For pregnant women, use of these medications also improves pregnancy outcomes, including the risk of preterm birth. Despite the known benefits of medications for opioid use disorder, many pregnant and nonpregnant women with the disorder are not receiving them.

Objective: To determine whether pregnancy and insurance status are associated with a woman's ability to obtain an appointment with an opioid use disorder treatment clinician.

Design, Setting, And Participants: In this cross-sectional study with random assignment of clinicians and simulated-patient callers (performed in "secret shopper" format), outpatient clinics that provide buprenorphine and methadone were randomly selected from publicly available treatment lists in 10 US states (selected for variability in opioid-related outcomes and policies) from March 7 to September 5, 2019. Pregnant vs nonpregnant woman and private vs public insurance assigned randomly to callers to create unique patient profiles. Simulated patients called the clinics posing as pregnant or nonpregnant women to obtain an initial appointment with a clinician.

Main Outcomes And Measures: Appointment scheduling, wait time, and out-of-pocket costs.

Results: A total of 10 871 unique patient profiles were assigned to 6324 clinicians. Among all women, 2312 of 3420 (67.6%) received an appointment with a clinician who prescribed buprenorphine, with lower rates among pregnant vs nonpregnant callers (1055 of 1718 [61.4%] vs 1257 of 1702 [73.9%]; relative risk, 0.83; 95% CI, 0.79-0.87). For clinicians who prescribed methadone, there was no difference in appointment access for pregnant vs nonpregnant callers (240 of 271 [88.6%] vs 237 of 265 [89.4%]; relative risk, 0.99; 95% CI, 0.93-1.05). Insurance was frequently not accepted, with 894 of 3420 buprenorphine-waivered prescribers (26.1%) and 174 of 536 opioid treatment programs (32.5%) granting appointments only when patients agreed to pay cash. Median wait times did not differ between pregnant and nonpregnant callers among buprenorphine prescribers (3 days [interquartile range, 1-7 days] vs 3 days [interquartile range, 1-7 days]; P = .43) but did differ among methadone prescribers (1 day [interquartile range, 1-4 days] vs 2 days [interquartile range, 1-6 days]; P = .049). For patients agreeing to pay cash, the median out-of-pocket costs for initial appointments were $250 (interquartile range, $155-$300) at buprenorphine prescribers and $34 (interquartile range, $15-$120) at methadone prescribers.

Conclusions And Relevance: In this cross-sectional study with random assignment of clinicians and simulated-patient callers, many women, especially pregnant women, faced barriers to accessing treatment. Given the high out-of-pocket costs and lack of acceptance of insurance among many clinicians, access to affordable opioid use disorder treatment is a significant concern.
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http://dx.doi.org/10.1001/jamanetworkopen.2020.13456DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7428808PMC
August 2020

Systematic review of the emerging literature on the effectiveness of naloxone access laws in the United States.

Addiction 2021 01 8;116(1):6-17. Epub 2020 Jul 8.

Network for Public Health Law, Edina, MN, USA.

Background And Aims: Naloxone access laws (NALs) have been suggested to be an important strategy to reduce opioid-related harm. We describe the evolution of NALs across states and over time and review existing evidence of their overall association with naloxone distribution and opioid overdose as well as the potential effects of specific NAL components.

Methods: Descriptive analysis of temporal variation in US regional adoption of NAL components, accompanied by a systematic search of 13 databases for studies (published between 2005 and 20 December 2019) assessing the effects of NALs on naloxone distribution or opioid-related health outcomes. Eleven studies, all published since 2018, met inclusion criteria. Study time-frames spanned 1999-2017. Opioid-related overdose mortality, emergency department episodes and naloxone distribution were correlated with the presence of a NAL and, where data were available, NAL components.

Results: Existing evidence suggests mixed, but generally beneficial, effects for NALs. Nearly all studies show that NALs, particularly those that permit naloxone distribution without patient-specific prescriptions, are associated with increased naloxone access [incidence rate ratios (IRR) range from 1.40, 95% confidence interval (CI) = 1.15-1.66 to 7.75, 95% CI = 1.22-49.35] and increased opioid-related emergency department visits (IRR range from 1.14, 95% CI = 1.07-1.20 to 1.15, 95% CI = 1.02-1.29). Most studies show NALs are associated with reduced overdose mortality, although findings vary depending on the specific NAL components and time-period analyzed (IRR range from 0.66, 95% CI = 0.42-0.90 to 1.27, 95% CI = 1.27-1.27). Few studies account for the variation in opioid environments (i.e. illicit versus prescription) or other policy dimensions that may be correlated with outcomes.

Conclusions: The existing literature on naloxone access laws in the United States supports beneficial effects for increased naloxone distribution, but provides inconclusive evidence for reduced fatal opioid overdose. Mixed findings may reflect variation in the laws' design and implementation, confounding effects of concurrent policy adoption, or differential effectiveness in light of changing opioid environments.
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http://dx.doi.org/10.1111/add.15163DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8051142PMC
January 2021

Opioid Policy Changes During the COVID-19 Pandemic - and Beyond.

J Addict Med 2020 Jul/Aug;14(4):e4-e5

The Network for Public Health Law, Los Angeles, CA (CSD); Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, RI (EAS).

: The United States is currently in the midst of 2 public health emergencies: COVID-19 and the ongoing opioid crisis. In an attempt to reduce preventable harm to individuals with opioid use disorder (OUD), federal, state, and local governments have temporarily modified law and policy to increase access to OUD treatment and divert some individuals at high risk away from the correctional system. In this Commentary, we briefly describe how people with OUD are at increased risk for COVID-19, discuss existing policy barriers to evidence-based prevention and treatment for individuals with OUD, explain the temporary rollbacks of those barriers, and argue that these changes should be made permanent. We also suggest several additional steps that federal and state governments can urgently take to reduce barriers to care for individuals with OUD, both during the current crisis and beyond.
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http://dx.doi.org/10.1097/ADM.0000000000000679DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7273953PMC
August 2020

Rise and regional disparities in buprenorphine utilization in the United States.

Pharmacoepidemiol Drug Saf 2020 06 16;29(6):708-715. Epub 2020 Mar 16.

Department of Medical Education, Geisinger Commonwealth School of Medicine, Scranton, Pennsylvania, USA.

Purpose: Buprenorphine is an opioid partial agonist used to treat opioid use disorder. While several policy changes have attempted to increase buprenorphine availability, access remains well below optimal levels. This study characterized how buprenorphine utilization in the United States has changed over time and whether there are regional disparities in distribution of the medication.

Methods: The amount of buprenorphine distributed from 2007 to 2017 was obtained from the Drug Enforcement Administration's Automated Reports and Consolidated Ordering System. Data were expressed as the percent change and milligrams per person in each state. The formulations and cost for prescriptions covered by Medicaid (2008 to 2018) were also examined.

Results: Buprenorphine distributed to pharmacies increased about 7-fold (476.8 to 3179.9 kg) while the quantities distributed to hospitals grew 5-fold (18.6 to 97.6 kg) nationally from 2007 to 2017. Buprenorphine distribution per person was almost 20-fold higher in Vermont (40.4 mg/person) relative to South Dakota (2.1 mg/person). There was a strong association between the number of physicians authorized to prescribe buprenorphine and distribution per state (r[49] = +0.94, P < .0005). The buprenorphine/naloxone sublingual film (Suboxone) was the predominant formulation (92.6% of 0.31 million Medicaid prescriptions) in 2008 but accounted for less than three-fifth (57.3% of 6.56 million prescriptions) in 2018.

Conclusions: Although buprenorphine availability has substantially increased over the last decade, distribution was very nonhomogeneous across the United States.
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http://dx.doi.org/10.1002/pds.4984DOI Listing
June 2020

Regional and temporal effects of naloxone access laws on opioid overdose mortality.

Subst Abus 2020 Jan 17:1-10. Epub 2020 Jan 17.

Network for Public Health Law, Los Angeles, California, USA.

Naloxone is a drug that reverses opioid overdose. Naloxone Access Laws (NALs) increase public access to naloxone and have been considered as one promising solution to reducing opioid-related harm. However, previous studies on whether NALs are effective in reducing opioid overdose mortality found somewhat contradictory results. Our study attempts to provide a more definitive answer to this question by utilizing an approach that matches NAL vs non-NAL states and stratifies by US region and years of implementation. We assess the causal impact of NALs on state-level opioid-related mortality rate by constructing a comparison group using matching to produce a valid counterfactual scenario, and estimating the effects of NAL using a semi-dynamic staggered difference in differences (DID) model that allows heterogeneous effects across regions and years of implementation. State-level opioid-related mortality data from CDC's WONDER database and NALs effective from 1999 to 2014 were utilized. We find that NAL effects have reduced fatal opioid-related overdose in western states and have produced minimal or no effects for other regions. The effects of NALs vary across regions and years of implementation. It is important to study the successful experience of the western states.
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http://dx.doi.org/10.1080/08897077.2019.1709605DOI Listing
January 2020

Association of Medicaid Expansion With Opioid Overdose Mortality in the United States.

JAMA Netw Open 2020 01 3;3(1):e1919066. Epub 2020 Jan 3.

Center for Opioid Epidemiology and Policy, Department of Population Health, New York University School of Medicine, New York.

Importance: The Patient Protection and Affordable Care Act (ACA) permits states to expand Medicaid coverage for most low-income adults to 138% of the federal poverty level and requires the provision of mental health and substance use disorder services on parity with other medical and surgical services. Uptake of substance use disorder services with medications for opioid use disorder has increased more in Medicaid expansion states than in nonexpansion states, but whether ACA-related Medicaid expansion is associated with county-level opioid overdose mortality has not been examined.

Objective: To examine whether Medicaid expansion is associated with county × year counts of opioid overdose deaths overall and by class of opioid.

Design, Setting, And Participants: This serial cross-sectional study used data from 3109 counties within 49 states and the District of Columbia from January 1, 2001, to December 31, 2017 (N = 3109 counties × 17 years = 52 853 county-years). Overdose deaths were modeled using hierarchical Bayesian Poisson models. Analyses were performed from April 1, 2018, to July 31, 2019.

Exposures: The primary exposure was state adoption of Medicaid expansion under the ACA, measured as the proportion of each calendar year during which a given state had Medicaid expansion in effect. By the end of study observation in 2017, a total of 32 states and the District of Columbia had expanded Medicaid eligibility.

Main Outcomes And Measures: The outcomes of interest were annual county-level mortality from overdoses involving any opioid, natural and semisynthetic opioids, methadone, heroin, and synthetic opioids other than methadone, derived from the National Vital Statistics System multiple-cause-of-death files. A secondary analysis examined fatal overdoses involving all drugs.

Results: There were 383 091 opioid overdose fatalities across observed US counties during the study period, with a mean (SD) of 7.25 (27.45) deaths per county (range, 0-1145 deaths per county). Adoption of Medicaid expansion was associated with a 6% lower rate of total opioid overdose deaths compared with the rate in nonexpansion states (relative rate [RR], 0.94; 95% credible interval [CrI], 0.91-0.98). Counties in expansion states had an 11% lower rate of death involving heroin (RR, 0.89; 95% CrI, 0.84-0.94) and a 10% lower rate of death involving synthetic opioids other than methadone (RR, 0.90; 95% CrI, 0.84-0.96) compared with counties in nonexpansion states. An 11% increase was observed in methadone-related overdose mortality in expansion states (RR, 1.11; 95% CrI, 1.04-1.19). An association between Medicaid expansion and deaths involving natural and semisynthetic opioids was not well supported (RR, 1.03; 95% CrI, 0.98-1.08).

Conclusions And Relevance: Medicaid expansion was associated with reductions in total opioid overdose deaths, particularly deaths involving heroin and synthetic opioids other than methadone, but increases in methadone-related mortality. As states invest more resources in addressing the opioid overdose epidemic, attention should be paid to the role that Medicaid expansion may play in reducing opioid overdose mortality, in part through greater access to medications for opioid use disorder.
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http://dx.doi.org/10.1001/jamanetworkopen.2019.19066DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6991255PMC
January 2020

Toward Healthy Drug Policy in the United States - The Case of Safehouse.

N Engl J Med 2020 Jan 4;382(1):4-5. Epub 2019 Dec 4.

From the Center for Public Health Law Research, Temple University Beasley School of Law (S.B.), and the School of Nursing and Perelman School of Medicine, University of Pennsylvania (E.D.A.) - all in Philadelphia; the Network for Public Health Law, Los Angeles (C.S.D.); and the School of Law, Bouvé College of Health Sciences, and Health in Justice Action Lab, Northeastern University, Boston (L.B.).

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http://dx.doi.org/10.1056/NEJMp1913448DOI Listing
January 2020

Over the counter naloxone needed to save lives in the United States.

Prev Med 2020 01 23;130:105932. Epub 2019 Nov 23.

Network for Public Health Law, Los Angeles, United States of America.

The United States continues to face a public health emergency of opioid-related harm, the effects of which could be dramatically reduced through increased access to the opioid antagonist naloxone. Unfortunately, naloxone is too often unavailable when and where it is most needed, partly due to its continued status as a prescription medication. Although states and the federal Food and Drug Administration (FDA) have acted to increase access to naloxone, these changes are insufficient to address this unprecedented crisis. In this Commentary, we argue that FDA can and should immediately reclassify naloxone from prescription-only to over-the-counter status, a change that could save hundreds if not thousands of lives in the United States every year.
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http://dx.doi.org/10.1016/j.ypmed.2019.105932DOI Listing
January 2020

Prescription drug monitoring programs operational characteristics and fatal heroin poisoning.

Int J Drug Policy 2019 12 15;74:174-180. Epub 2019 Oct 15.

Department of Population Health, NYU School of Medicine, New York, NY, United States.

Background: Prescription drug monitoring programs (PDMP), by reducing access to prescribed opioids (POs), may contribute to a policy environment in which some people with opioid dependence are at increased risk for transitioning from POs to heroin/other illegal opioids. This study examines how PDMP adoption and changes in the characteristics of PDMPs over time contribute to changes in fatal heroin poisoning in counties within states from 2002 to 2016.

Methods: Latent transition analysis to classify PDMPs into latent classes (Cooperative, Proactive, and Weak) for each state and year, across three intervals (1999-2004, 2005-2009, 2010-2016). We examined the association between probability of PDMP latent class membership and the rate of county-level heroin poisoning death.

Results: After adjustment for potential county-level confounders and co-occurring policy changes, adoption of a PDMP was significantly associated with increased heroin poisoning rates (22% increase by third year post-adoption). Findings varied by PDMP type. From 2010-2016, states with Cooperative PDMPs (those more likely to share data with other states, to require more frequent reporting, and include more drug schedules) had 19% higher heroin poisoning rates than states with Weak PDMPs (adjusted rate ratio [ARR] = 1.19; 95% CI = 1.14, 1.25). States with Proactive PDMPs (those more likely to report outlying prescribing and dispensing and provide broader access to law enforcement) had 6% lower heroin poisoning rates than states with No/Weak PDMPs (ARR = 0.94; 95% CI = 0.90, 0.98).

Conclusion: There is a consistent, positive association between state PDMP adoption and heroin poisoning mortality. However, this varies by PDMP type, with Proactive PDMPs associated with a small reduction in heroin poisoning deaths. This raises questions about the potential for PDMPs to support efforts to decrease heroin overdose risk, particularly by using proactive alerts to identify patients in need of treatment for opioid use disorder. Future research on mechanisms explaining the reduction in heroin poisonings after enactment of Proactive PDMPs is merited.
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http://dx.doi.org/10.1016/j.drugpo.2019.10.001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6897357PMC
December 2019

Will Emergency Holds Reduce Opioid Overdose Deaths?

N Engl J Med 2019 Nov 16;381(19):1795-1797. Epub 2019 Oct 16.

From the Departments of Emergency Medicine (E.A.S., O.U.W.) and Psychiatry and Human Behavior (P.P.C.), Warren Alpert Medical School, Brown University, Providence, RI; and the Network for Public Health Law, Los Angeles (C.S.D.).

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http://dx.doi.org/10.1056/NEJMp1907692DOI Listing
November 2019

Measuring Relationships Between Proactive Reporting State-level Prescription Drug Monitoring Programs and County-level Fatal Prescription Opioid Overdoses.

Epidemiology 2020 01;31(1):32-42

Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY.

Background: Prescription drug monitoring programs (PDMPs) that collect and distribute information on dispensed controlled substances have been adopted by nearly all US states. We know little about program characteristics that modify PDMP impact on prescription opioid (PO) overdose deaths.

Methods: We measured associations between adoption of any PDMP and changes in fatal PO overdoses in 2002-2016 across 3109 counties in 49 states and D.C. We then measured changes related to the adoption of "proactive PDMPs," which report outlying prescribing/dispensing patterns and provide broader access to PDMP data by law enforcement. Comparisons were made within 3 time intervals that broadly represent the evolution of PDMPs (2002-2004, 2005-2009, and 2010-2016). We modeled overdoses using Bayesian space-time models.

Results: Adoption of electronic PDMP access was associated with 9% lower rates of fatal PO overdoses after three years (rate ratio [RR] = 0.91, 95% credible interval [CI]: 0.88-0.93) with well-supported effects for methadone (RR = 0.86,95% CI: 0.82-0.90) and other synthetic opioids (RR = 0.82, 95% CI: 0.77-0.86). Compared with states with no/weak PDMPs, proactive PDMPs were associated with fewer deaths attributed to natural/semi-synthetic opioids (2002-2004: RR = 0.72 [0.66-0.78]; 2005-2009: RR = 0.93 [0.90-0.97]; 2010-2016: 0.89 [0.86-0.92]) and methadone (2002-2004: RR = 0.77 [0.69-0.85]; 2010-2016: RR = 0.90 [0.86-0.94]). Unintended effects were observed for synthetic opioids other than methadone (2005-2009: RR = 1.29 [1.21-1.38]; 2010-2016: RR = 1.22 [1.16-1.29]).

Conclusions: State adoption of PDMPs was associated with fewer PO deaths overall while proactive PDMPs alone were associated with fewer deaths related to natural/semisynthetic opioids and methadone, the specific targets of these programs. See video abstract at, http://links.lww.com/EDE/B619.
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http://dx.doi.org/10.1097/EDE.0000000000001123DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7027962PMC
January 2020

Paraphernalia Laws, Criminalizing Possession and Distribution of Items Used to Consume Illicit Drugs, and Injection-Related Harm.

Am J Public Health 2019 11 19;109(11):1564-1567. Epub 2019 Sep 19.

Corey S. Davis and Derek H. Carr are with the Network for Public Health Law, Los Angeles, CA. Corey S. Davis is also with the Brody School of Medicine, East Carolina University, Greenville, NC. Elizabeth A. Samuels is with the Department of Emergency Medicine, Warren Alpert Medical School, Brown University, Providence, RI.

The United States remains in the grip of an unprecedented epidemic of drug-related harm. Infections of HIV, hepatitis C, and endocarditis related to lack of access to new syringes and subsequent syringe sharing among people who inject drugs have increased alongside a surge in opioid overdose deaths.Overwhelming evidence shows that using a new syringe with every injection prevents injection-related blood-borne disease transmission. Additionally, there is promising research suggesting that the distribution of fentanyl test strips to people who inject drugs changes individuals' injection decisions, which enables safer drug use and reduces the risk of fatal overdose. However, laws prohibiting the possession of syringes and fentanyl test strips persist in nearly every state.The full and immediate repeal of state paraphernalia laws is both warranted and needed to reduce opioid overdose death and related harms. Such repeal would improve the health of people who inject drugs and those with whom they interact, reducing the spread of blood-borne disease and fatal overdose associated with infiltration of illicitly manufactured fentanyl into the illicit drug supply. It would also free up scarce public resources that could be redirected toward evidence-based approaches to reducing drug-related harm.
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http://dx.doi.org/10.2105/AJPH.2019.305268DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6775926PMC
November 2019

Opioid Prescribing Laws Are Not Associated with Short-term Declines in Prescription Opioid Distribution.

Pain Med 2020 03;21(3):532-537

Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.

Objective: To determine whether the adoption of laws that limit opioid prescribing or dispensing is associated with changes in the volume of opioids distributed in states.

Methods: State-level data on total prescription opioid distribution for 2015-2017 were obtained from the US Drug Enforcement Administration. We included in our analysis states that enacted an opioid prescribing law in either 2016 or 2017. We used as control states those that did not have an opioid prescribing law during the study period. To avoid confounding, we excluded from our analysis states that enacted or modified mandates to use prescription drug monitoring programs (PDMPs) during the study period. To estimate the effect of opioid prescription laws on opioid distribution, we ran ordinary least squares models with indicators for whether an opioid prescription law was in effect in a state-quarter. We included state and quarter fixed effects to control for time trends and time-invariant differences between states.

Results: With the exception of methadone and buprenorphine, the amount of opioids distributed in states fell during the study period. The adoption of opioid prescribing laws was not associated with additional decreases in opioids distributed.

Conclusions: We did not detect an association between adoption of opioid prescribing laws and opioids distributed. States may instead wish to pursue evidence-based efforts to reduce opioid-related harm, with a particular focus on treatment access and harm reduction interventions.
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http://dx.doi.org/10.1093/pm/pnz159DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7060402PMC
March 2020

Legal and policy changes urgently needed to increase access to opioid agonist therapy in the United States.

Int J Drug Policy 2019 11 20;73:42-48. Epub 2019 Jul 20.

ChangeLab Solutions, 2201 Broadway, Suite 502, Oakland, CA 94612, United States. Electronic address:

The United States continues to face a public health crisis of opioid-related harm, the effects of which could be dramatically reduced through increased access to opioid agonist therapy with the medications methadone and buprenorphine. Despite overwhelming evidence of their efficacy, unduly restrictive federal, state, and local regulation significantly impedes access to these life-saving medications. We outline immediate, concrete steps that federal, state, and local governments can take to change law from barrier to facilitator of evidence-based treatment for opioid use disorder. These include removing onerous restrictions on the prescription and dispensing of buprenorphine and methadone for opioid agonist therapy, requiring insurance coverage of these medications, and mandating that they be provided in correctional settings and promoted by drug courts. Finally, we argue that jurisdictions should proactively offer opioid agonist therapy to individuals at high risk of overdose, remove barriers to establishing methadone treatment facilities, and address underlying social determinants and barriers to treatment. These changes have the ability to save thousands of lives annually.
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http://dx.doi.org/10.1016/j.drugpo.2019.07.006DOI Listing
November 2019

Association between medical cannabis laws and opioid overdose mortality has reversed over time.

Proc Natl Acad Sci U S A 2019 06 10;116(26):12624-12626. Epub 2019 Jun 10.

Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA 94305.

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http://dx.doi.org/10.1073/pnas.1903434116DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6600903PMC
June 2019

Bias Against People Who Inject Drugs Undermines Police Training on Needlestick Injury.

Authors:
Corey S Davis

Am J Public Health 2019 06;109(6):839-840

The author is with the Network for Public Health Law, Los Angeles, CA, and the Brody School of Medicine, East Carolina University, Greenville, NC.

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http://dx.doi.org/10.2105/AJPH.2019.305096DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6507983PMC
June 2019

Commentary on Neale et al. (2019): Foregrounding the competency, expertise and rights of people who use drugs.

Authors:
Corey S Davis

Addiction 2019 04;114(4):719-720

Network for Public Health Law, Edina, MN, USA.

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http://dx.doi.org/10.1111/add.14572DOI Listing
April 2019

Davis et al. Respond.

Am J Public Health 2019 Jan;109(1):e11-e12

Corey S. Davis, Hector Hernandez-Delgado, and Amy Judd Lieberman are with the Network for Public Health Law, Los Angeles, CA. Traci C. Green is with Boston University School of Medicine, Boston, MA, and the Warren Alpert School of Medicine of Brown University, Providence, RI.

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http://dx.doi.org/10.2105/AJPH.2018.304820DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6301404PMC
January 2019