Compassion, stigma, and professionalism among emergency personnel responding to the opioid crisis: An exploratory study in New Hampshire, USA.

OBJECTIVE: Drug overdoses are the leading cause of death in the United States for those under 50 years of age, and New Hampshire has been disproportionately affected, resulting in increased encounters with the emergency response system. The ensuing impact on emergency personnel has received little attention. The present study aimed to explore the experiences and perspectives of emergency personnel responding to the opioid crisis in NH, with a focus on their views toward people who use opioids. METHODS: Thirty-six emergency personnel (emergency department clinicians, n = 18; emergency medical service providers, n = 6; firefighters, n = 6; and police officers, n = 6) in 6 New Hampshire counties were interviewed about their experiences responding to overdoses and their perspectives on individuals who use opioids. Directed content analysis was used to identify themes in the transcribed, semistructured interviews. The results were reviewed for consensus. RESULTS: Several categories of themes were identified among emergency personnel's accounts of their overdose response experiences and perspectives, including varied degrees of compassion and stigma toward people who use opioids; associations between compassion or stigma and policy- and practice-related themes, such as prehospital emergency care and the role of emergency departments (EDs); and primarily among personnel expressing compassion, a sense of professional responsibility that outweighed personal biases. CONCLUSIONS: Despite the magnitude of the ongoing opioid crisis, some emergency personnel in New Hampshire have sustained or increased their compassion for people who use opioids. Others' perspectives remain or have become increasingly stigmatizing. The associations of compassion and stigma with various policy- and practice-related themes warrant further investigation

Medicaid managed care enrollment and maternal health outcomes among pregnant people with substance use disorders

Pregnant people with substance use disorders (SUD) are at high risk of potentially avoidable morbidity and mortality. In particular, pregnant people with opioid use disorder (OUD) have experienced large increases in maternal mortality, largely driven by rising rates of drug overdose. The majority of pregnant people with SUD receive health insurance through state Medicaid programs, many of which use private Medicaid managed care (MMC) plans to finance and deliver health care services rather than through the state-run fee-for-service (FFS) plan. MMC plans receive capitated payments in exchange for coverage of a defined set of benefits. Pregnant people with SUD are predictably high-cost and high-need, and MMC plans may not be able to recoup the high cost of services used over often short periods of enrollment associated with pregnancy. While capitation may incentivize MMC plans to promote access to high-value services that reduce the risk of poor maternal health outcomes, it might also incentivize plans to restrict access to certain services or alter their provider networks in ways that reduce costs. Despite being the dominant delivery vehicle of insurance coverage to this growing population, no research has examined the association between MMC enrollment and maternal health outcomes among pregnant people with any SUD or with OUD. In this Dissertation, I use the newly-available Transformed Medicaid Statistical Information System Analytic Files (TAF) across all three studies. The newly-available TAF files contain claims data for all Medicaid enrollees from all 50 states and the District of Columbia, and represent the most comprehensive data source for longitudinal inpatient and outpatient health service utilization among Medicaid enrollees. In the first study, I develop and validate an algorithm to identify live births using the TAF data. I find that using claims in both the inpatient and other services files are critical to accurately capture live births at the state-year and state-month level. In the second study, I first estimate the burden of SUD and OUD among pregnant people enrolled in Medicaid, and the prevalence of adverse maternal health outcomes in these groups. Next, I examine the association of severe maternal morbidity (SMM) and MMC enrollment among pregnant people with SUD and, separately, OUD nationally from 2016-2018. I find that SMM within six weeks of delivery is more prevalent among those with any SUD (3.2%) and OUD (3.9%) than those without either diagnosis (1.6%). Moreover, I find that enrollment in MMC (vs. Medicaid FFS) is associated with a 0.54 percentage-point (pp) and a 0.66 pp reduction in the probability of SMM among those with any SUD and among those with OUD, respectively. In the third study, I estimate the effect of MMC enrollment on adverse maternal health outcomes using data from two states (Illinois and Missouri) that expanded MMC to statewide. Using difference-in-differences models, I find that expansion of MMC did not change the probability of adverse maternal health outcomes among pregnant people with any SUD. These results suggest that at a minimum MMC has not worsened health outcomes among those with SUD, and at best, MMC may be driving incremental improvements for this group at high-risk of morbidity and mortality.2025-07-25T00:00:00

Medicaid policy data for evaluating eligibility and programmatic changes

Abstract Objectives Medicaid and the Children’s Health Insurance Program (CHIP) provide health insurance coverage to more than 90 million Americans as of early 2023. There is substantial variation in eligibility criteria, application procedures, premiums, and other programmatic characteristics across states and over time. Analyzing changes in Medicaid policies is important for state and federal agencies and other stakeholders, but such analysis requires data on historical programmatic characteristics that are often not available in a form ready for quantitative analysis. Our objective is to fill this gap by synthesizing existing qualitative policy data to create a new data resource that facilitates Medicaid policy research. Data description Our source data were the 50-state surveys of Medicaid and CHIP eligibility, enrollment, and cost-sharing policies, and budgets conducted near annually by KFF since 2000, which we coded through 2020. These reports are a rich source of point-in-time information but not operationalized for quantitative analysis. Through a review of the measures captured in the KFF surveys, we developed five Medicaid policy domains with 122 measures in total, each coded by state-quarter—1) eligibility (28 measures), 2) enrollment and renewal processes (39 measures), 3) premiums (16 measures), 4) cost-sharing (26 measures), and 5) managed care (13 measures)

Sequential and simultaneous treatment approaches to cannabis use disorder and tobacco use

Tobacco smoking among those seeking treatment for cannabis use disorder (CUD) is common and is a negative predictor of cannabis outcomes. Quitting tobacco may be beneficial for those seeking to quit cannabis use. This initial proof of concept, controlled trial was designed to compare a simultaneous versus sequential tobacco intervention among those seeking treatment for CUD. Sixty-seven adults received either a simultaneous (SIM) or sequential (SEQ) approach to tobacco cessation in the context of outpatient treatment for CUD. A tobacco intervention (TI) that combined web-based counseling with nicotine replacement therapy (NRT) was provided during weeks 1-12 for SIM and was delayed until weeks 13-24 for SEQ. During weeks 1-12, no between-condition significant differences were observed on treatment participation or cannabis use outcomes. The majority of SIM participants initiated TI counseling (62%), 50% made at least one quit attempt and 41% initiated NRT. Interestingly, 39% in SEQ made tobacco quit attempts and 18% initiated NRT on their own before the TI was offered to them. However, only 30% of those in SEQ continued treatment during weeks 13-24, which compromised between-condition comparisons following the TI, but illustrated a potential clinical concern with delaying the TI. Tobacco cessation outcomes generally were poor and did not differ between conditions. This initial controlled trial suggests that addressing tobacco use during CUD treatment is acceptable and generates action towards tobacco cessation. Additional trials testing more intensive TI models may be necessary to identify more efficacious interventions for co-use of cannabis and tobacco

Reproducibility of fluorescent expression from engineered biological constructs in E. coli

We present results of the first large-scale interlaboratory study carried out in synthetic biology, as part of the 2014 and 2015 International Genetically Engineered Machine (iGEM) competitions. Participants at 88 institutions around the world measured fluorescence from three engineered constitutive constructs in E. coli. Few participants were able to measure absolute fluorescence, so data was analyzed in terms of ratios. Precision was strongly related to fluorescent strength, ranging from 1.54-fold standard deviation for the ratio between strong promoters to 5.75-fold for the ratio between the strongest and weakest promoter, and while host strain did not affect expression ratios, choice of instrument did. This result shows that high quantitative precision and reproducibility of results is possible, while at the same time indicating areas needing improved laboratory practices.Peer reviewe