News

Years of sustained and coordinated efforts will be required to contain and reverse the harmful societal effects of the prescription and illicit opioid epidemics, which are intertwined and getting worse, says a new report from the National Academies of Sciences, Engineering, and Medicine. The report, requested by the U.S. Food and Drug Administration (FDA), says it is possible to stem the still-escalating prevalence of opioid use disorder and other opioid-related harms without foreclosing access to opioids for patients suffering from pain whose providers have prescribed these drugs responsibly. The committee that conducted the study and wrote the report recommended actions the FDA, other federal agencies, state and local governments, and health-related organizations should take – which include promoting more judicious prescribing of opioids, expanding access to treatment for opioid use disorder, preventing more overdose deaths, weighing societal impacts in opioid-related regulatory decisions, and investing in research to better understand the nature of pain and develop non-addictive alternatives.

As of 2015, at least 2 million people in the United States have an opioid use disorder involving prescription opioids – meaning they are addicted to prescription opioids – and almost 600,000 have an opioid use disorder involving heroin. An average of about 90 Americans die every day from overdoses that involve an opioid. While the annual number of deaths from prescription opioids remained relatively stable between 2011 and 2015, overdose deaths from illicit opioids – including heroin and synthetic opioids such as fentanyl – nearly tripled during this time period, partially in connection to a growing number of people whose use began with prescription opioids. Drug overdose, driven primarily by opioids, is now the leading cause of unintentional injury deaths in the United States, and trends indicate that premature deaths associated with the use of opioids are likely to climb.

With this in mind, one approach to addressing the opioid epidemic is to have a fundamental shift in the nation’s approach to prescribing practices and improve awareness of the risks and benefits of opioids. To this end, the committee recommended enhancing education for both health professionals and the general public. Such education should involve mandating pain-related education for all health professionals who provide care to people with pain, requiring and providing basic training in the treatment of opioid use disorder for health care providers, and training prescribers and pharmacists to recognize and counsel patients who are at risk for opioid use disorder or overdose. In addition, the committee was struck by the relative lack of attention to educating the general public about the risks and benefits of prescription opioids and called for an evaluation of the impact and cost of an education program that raises awareness among patients with pain and the general public.

Read more on NationalAcademies.org. Read the full report.

The Office of Juvenile Justice and Delinquency Prevention (OJJDP) Tribal Youth Training and Technical Assistance Center has launched its new website. This website serves as a clearinghouse of culturally appropriate resources, training, and technical assistance to help OJJDP tribal grantees and federally recognized tribes improve, enhance, and support their juvenile justice systems. The website provides information in areas such as juvenile healing to wellness courts; tribal youth-specific prevention, intervention, and treatment programming; and tribal-state collaborations to meet the needs of American Indian/Alaska Native children exposed to violence.

Visit the website.

While long drives and limited access to health care are familiar burdens for many rural residents, the problem is particularly acute for veterans in those areas. They are far older than other rural residents, and far more likely to be disabled, meaning more of them are in need of medical care. And there are a lot of them—one in four veterans lives in rural areas, compared to one in five adults in the general population, according to 2015 census data.

While there is a general lack of doctors and hospitals in rural areas, the situation is even worse for veterans who rely on the VA, said John Hoellwarth, a spokesperson for American Veterans, the nation’s largest veterans’ organization. In recent years, the VA has set up more community-based clinics, and the Obama administration created a program, called Choice, that allows non-VA clinicians to serve rural veterans and receive reimbursement from the VA. But the problem persists.

Many rural veterans rely on a combination of VA health insurance and other forms of insurance, such as private insurance, Medicaid (the joint federal-state health insurance program for the poor and disabled), or Medicare (federal health program for the elderly), according to census data. The number of veterans enrolled in Medicaid increased by about 340,000 under the Affordable Care Act, according to an analysis by Families USA, a nonprofit that advocates for high-quality, affordable health care.

For veterans in rural areas, “Medicaid could mean the difference between them getting care, and them not getting care,” said Andrea Callow, Families USA associate director of Medicaid initiatives.

To improve care for rural veterans, the VA needs to expand both the services it provides and the services it pays others to provide, said Margaret Puccinelli, chairwoman of the Veterans Rural Health Advisory Committee, which makes recommendations to Secretary of Veterans Affairs David Shulkin.

Read more on PBS.org.

The McLennan County Jail in Waco Texas hosted a graduation ceremony for nine inmates in the McLennan County Reintegration Program (MCRP) on July 24. The program helps inmates who have been in-and-out of jail and often struggling with substance abuse by providing services like counseling, substance abuse treatment, education, and job training including a six-week workforce training certification through McLennan Community College.

The help appears to be working: only one of the 67 program participants have “recidivated” (returned to jail) since the pilot program launched in November of 2016.

MCRP is created and initially funded through a partnership with McLennan County, the City of Waco, and the Heart of Texas Region Mental Health and Mental Retardation Center. Recent grant funding has added to the program’s continuation.

The program, which was in the works back in 2012, allows services to begin during incarceration, rather than waiting until release. The inmates who participate in the six-part program receive support with employment, housing, education, social connection, and mental health and substance use disorder treatment, including Alcoholics Anonymous and Narcotics Anonymous classes.

The pre-release part of the program has four phases, and provides individuals with the skills needed for successful reintegration, according to officials. Participants work on the final two phases once they’re released back into society and are no longer incarcerated.

Read more on KWTX.com.

Children who grow up in urban counties with high upward mobility exhibit fewer behavioral problems and perform better on cognitive tests, according to a study led by Princeton University. Children in these counties display fewer behavior problems at age 3 and show substantial gains in cognitive test scores between ages 3 and 9. Growing up in a county with higher intergenerational mobility reduces the gap between economically advantaged and disadvantaged children’s cognitive and behavioral outcomes by around 20 percent.

The study, published Aug. 14 in the Proceedings of the National Academy of Sciences, provides further evidence that place, measured at the county level, has a significant influence over the economic prospects of children from low-income families.

The study results are based on data from the Fragile Families and Child Wellbeing Study, of which McLanahan, who is founding director of the Bendheim-Thoman Center for Research on Child Wellbeing, is a principal investigator. The study is a population-based birth-cohort study of children born in 20 large U.S. cities between 1998 and 2000.

For their analyses, the researchers looked at 4,226 children from 562 U.S. counties whose developmental outcomes were assessed at approximately ages 3, 5 and 9 years old. The researchers divided these children into low- and high-income groups based on household income at birth. Children from low-income families were born in households earning below the national median household income (mean of $18,282), while children from high-income families were born in families earning above the national median (mean of $73,762).

Behavioral problems—like aggression and rule-breaking—were assessed by parents and teachers using the Child Behavior Checklist, a report used in both research and clinical settings, along with the Social Skills Rating Scale, a system that evaluates social skills, problem behaviors and academic competence. Cognitive abilities were assessed through a series of vocabulary, reading comprehension and applied problems tests in the children’s homes. Both assessments were collected as part of the Fragile Families and Child Wellbeing Study.

After analyzing the data, the researchers found that children from low-income families who grew up in counties with high upward mobility had fewer behavior problems and higher cognitive test scores when compared with children from counties with lower mobility. These differences were significant even after controlling for a large set of family characteristics, including parents’ race/ethnicity, education, intelligence, impulsivity and mental health.

Read more on Phys.org.

What coping resources help ethnic minority adolescents deal with racial/ethnic discrimination? A new study published in Child Development addressed this question by testing the role of ethnic identity, social support, and anger regulation as potential buffers that may help offset the negative impact of discrimination on the mental health of Mexican-origin adolescents living in the Midwestern United States.

In prior research, racial/ethnic discrimination has consistently been associated with poor mental health outcomes. Consequently, it is important to help identify effective coping strategies for youths who experience discrimination. However, many questions remain unanswered regarding which coping strategies are effective in reducing the detrimental impact of discrimination on psychological adjustment, particularly among immigrant Latino youths.

Study participants were 269 Mexican-origin adolescents who were 12-17 years old, recruited from public schools, churches and community-based organizations in a Midwestern region. Youths completed survey questionnaires on laptop computers at three time points, spaced approximately four months apart. The majority of the youths were born in the U.S. (71 percent), with the remainder born in Mexico (29 percent). All adolescents came from families where both biological parents were also from Mexico. The adolescent participants were asked to complete questions about their discrimination experiences (e.g., if they had been called an insulting name or witnessed a family member being treated unfairly because of the color of their skin, accent, or cultural background), ethnic identity (e.g., how good or proud they feel about being Mexican, how much they engage in cultural practices or how much time they spend trying to find out about their cultural background), social support from their family, friends or significant others, and the degree to which they suppressed or expressed their anger.

Overall, the authors found that a strong ethnic identity and greater social support were protective factors in the link between discrimination and adjustment problems in this sample of Mexican-origin youths. That is, having a stronger ethnic identity or more social support weakened the link between discrimination and adjustment problems. Anger suppression also acted as a protective factor. On the other hand, we found that outward anger expression was a risk factor. That is, outward anger expression tended to exacerbate the association between discrimination and adjustment problems. Importantly, these protective and risk factors differed according to the level of analysis.

Read more on Medicine.IU.edu. Read the abstract of the study.