Guest essay from Brendan Saloner
 ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌

Problems viewing this email?

View Message In Browser

Thursday, May 12, 2022 | The Latest Research, Commentary, And News From
Health Affairs

Dear John,

Today's Health Affairs newsletter includes a guest essay from Brendan
Saloner, associate professor at Johns Hopkins Bloomberg School of Public
Health.

Substance Use Disorder Treatment

Drug overdose deaths in the US have risen relentlessly in recent years,
topping more than 100,000 per year

in the most recent federal data. This grim milestone has been largely
overshadowed by the COVID-19 pandemic.

Yet the pandemic has exacerbated the isolation of many people with
substance use disorders (SUDs) and increased the risks of solitary drug
use amid an increasingly lethal and unpredictable drug supply.

In this context, improving access to treatment and other health care
services is a critical priority.

Past studies

have shown that in a given year very few people-perhaps only one in
ten-who meet the screening criteria for SUD use any treatment. It is
unclear whether use of treatment has increased over time.

Insurance expansions under the Affordable Care Act greatly increased the
availability of comprehensive Medicaid or subsidized Marketplace plans.

More recent federal laws, such as the State Opioid Response grants, have
funneled resources to state governments to spend on expanding services.

In the May issue of Health Affairs
,
my colleagues and I look back at the decade from 2010 to 2019 to
understand trends in the use of services among people with SUDs.

Read The Study

The National Survey on Drug Use and Health (NSDUH) is an annual
cross-sectional survey of noninstitutionalized Americans.

We focused our analysis on people in the NSDUH who reported past-year
symptoms of an SUD, such as significant impairment related to the use of
drugs or alcohol.

Disappointingly, we find that use of SUD treatment in this population
did not significantly improve over the decade.

The lack of progress was broad-use of treatment was largely flat when
we looked across racial/ethnic groups, income groups, and types of
substance use disorder.

The lone bright spot is that we did find slightly increased use of
treatment over the decade among people who had been in contact with the
criminal legal system.

By contrast, when we examined the population with SUD we found that they
were making progress in other overall metrics of health care access.

For example, there was a substantial decrease in the uninsured rate
among people with SUD, largely due to increased Medicaid enrollment.
More people with SUD were receiving care in a doctor's office or
clinic.

Among those who did get SUD treatment, they were more likely to report
that this treatment was covered by their health insurance rather than
relying on either a safety-net program or their own out-of-pocket
payment.

Our main takeaway from this study is that increasing utilization of SUD
treatment is a persistent and unresolved challenge.

While the past decade brought better insurance coverage and access to
care overall for people with SUD, it did not fundamentally change the
probability that they would receive treatment-whether in a specialty
clinic, an inpatient rehab, or a doctor's office.

What is needed to meaningfully close the gap in use of treatment?

While our study cannot answer these questions, several ideas are worth
considering:

Creating more "on-ramps" to treatment: Our treatment system remains
difficult to navigate, especially for people in crisis. A key ingredient
in expanding treatment is ensuring that there are points of referral
whether they be in primary care, hospital emergency departments, or
jails.

Investing in the workforce: There are not enough addiction specialists
to meet the current need. Expanding the workforce requires steps such as
increasing the number of advanced practice providers and physicians to
treat opioid use disorder with medication, training more counselors, and
expanding the number of peer-recovery specialists.

Reducing stigma: While the opioid crisis has created more public
awareness of addiction, there remains profound stigma against people
with SUDs, which can reduce their willingness to seek help. Public
campaigns to celebrate recovery and promote more effective treatment may
be helpful in reducing stigma.

The past decade created some of the building blocks for a better SUD
treatment system, but the promise of better access to care remains
largely unfulfilled.

Using the existing financing and organizational framework to build a
patient-centered system of SUD care remains a critical challenge for the
future.

Read The Study

Brendan Saloner's Reading List

I try to read widely on issues related substance use policy. Here are
three of my book recommendations:

Fighting For Space: How a Group of Drug Users Transformed One City's
Struggle with Addiction
: In the 1990s, a
grassroots movement emerged in the Downtown East area of Vancouver,
British Columbia, focused on the health and safety of people who used
drugs. Travis Lupick tells the extraordinary story of community
organizing that led to Canada's first safe-consumption site.

Addicts Who Survived: An Oral History of Narcotic Use in America,
1923-1965
:
The word "addict" itself has fallen out of favor since this book was
published in 1989, but the stories in this book by David Courtwright,
Herman Joseph, and Don Des Jarlais provide an invaluable window into the
struggles and stories of people who used drugs during an extremely
prohibitionist period in the US, and has many intriguing connections to
current struggles.

The Opioid Epidemic: What Everyone Needs to Know
:
This book is a wholly accessible overview of some of the major issues
related to the opioid epidemic. Josh Sharfstein and Yngvild Olsen do a
magnificent job of connecting history, politics, medicine, and public
health into a book you can easily read on a cross-country flight.

[link removed]

Halfway Around The World, Echoes Of Physician Moral Injury

A physician seeks respite from the injustice of US care delivery but
encounters familiar signals of system failure abroad.

Listen Here

Elsewhere At Health Affairs

Today in Health Affairs Forefront, Bobby Milstein and coauthors discuss
how amid nationwide calls to end systemic racism and other forms of
injustice, a new survey finds that only a small fraction of
organizational leaders prioritize equitable investment
.

Elevating Voices: Asian American and Pacific Islander American Heritage
Month: In their Health Affairs Forefront article, Rohan Khazanchi and
coauthors call for state and federal policy makers to be intentional
about advancing pharmacoequity
.

Daily Digest

Trends In The Use Of Treatment For Substance Use Disorders, 2010-19

Brendan Saloner et al.

Shared Stewardship: Who Is Willing To Invest In People And Places With
The Most To Gain?
Bobby
Milstein et al.

Race, Racism, Civil Rights Law, And The Equitable Allocation Of Scarce
COVID-19 Treatments

Rohan Khazanchi et al.

Podcast: Halfway Around The World, Echoes Of Physician Moral Injury

Jason Prior

 

[link removed]

[link removed]

 

[link removed]

 

[link removed]

 

[link removed]

 

mailto:[email protected]

About Health Affairs

Health Affairs is the leading peer-reviewed journal
at the intersection of health,
health care, and policy. Published monthly by Project HOPE, the journal
is available in print and online. Late-breaking content is also found
through healthaffairs.org , Health Affairs Today
, and Health Affairs Sunday
Update .  

Project HOPE is a global health and
humanitarian relief organization that places power in the hands of local
health care workers to save lives across the globe. Project HOPE has
published Health Affairs since 1981.

Copyright © Project HOPE: The People-to-People Health Foundation, Inc.

Health Affairs, 1220 19th Street, NW, Suite 800, Washington, DC 20036, United States

Privacy Policy

To unsubscribe from this email, update your email preferences here
.
_________________

Sent to [email protected]

Unsubscribe:
[link removed]

Health Affairs, 1220 19th Street, NW, Suite 800, Washington, DC 20036, United States