2024 Bloomberg American Health Summit in Washington, D.C., to Spotlight Concrete Ways to Advance Public Health Amid Political Division

The seventh Bloomberg American Health Summit organized by the Bloomberg American Health Initiative will bring together public health leaders, government officials, community organizations, researchers, and students to discuss evidence-based health policies that remain critical to advancing health in a politically divided country. The Summit will take place on December 3 in Washington, D.C.

Following the recent U.S. election, this year’s event, “Advancing Public Health in Uncertain Political Times,” will underscore the essential role of evidence and policy to address preventable illness that is holding back American life expectancy and progress. The Summit will also emphasize how fostering bipartisan collaboration, reforming policies that drive health disparities, and using innovative methods to enhance policy impact are essential to safeguard public health.

Keynote discussions will cover urgent topics including:

  • Building bipartisan support for public health initiatives in 2025 and beyond
  • Protecting reproductive health
  • Defending the role of science in uncertain political times

Featured speakers include:

  • Jerome Adams, Former U.S. Surgeon General & Director of Health Equity, Purdue University
  • Xavier Becerra, Secretary, U.S. Department of Health and Human Services
  • Michael R. Bloomberg, Founder of Bloomberg L.P. and Bloomberg Philanthropies, WHO Global Ambassador for Noncommunicable Diseases and Injuries, and 108th mayor of New York City
  • Cory Booker, U.S. Senator (D-NJ)
  • Muriel Bowser, Mayor, Washington, D.C.
  • Jonathan Capehart, Associate Editor, The Washington Post 
  • Francis S. Collins, Distinguished Investigator, National Institutes of Health
  • Ron Daniels, President, Johns Hopkins University
  • Madlen Davies, Senior Editor, The Examination
  • Rosa DeLauro, Congresswoman, U.S. House of Representatives, Connecticut
  • Thomas Dobbs, Former Mississippi State Health Officer
  • Jamie Ducharme, Health Correspondent, TIME Magazine
  • John Feinblatt, President, Everytown for Gun Safety
  • Brian Fitzpatrick, U.S. Representative, Pennsylvania 
  • Cynthia Bissett Germanotta, President and Co-Founder, Born This Way Foundation
  • Riley Griffin, Health Care Reporter, Bloomberg News
  • Ellen J. MacKenzie, Dean, Johns Hopkins Bloomberg School of Public Health
  • Marion Nestle, Paulette Goddard Professor of Nutrition, Food Studies, and Public Health, Emerita, New York University
  • Joshua M. Sharfstein, Director, Bloomberg American Health Initiative
  • Michelle Spencer, Deputy Director, Bloomberg American Health Initiative
  • Sheryl Gay Stolberg, Washington Correspondent, The New York Times
  • Yasmin Tayag, Staff Writer, The Atlantic

Additional speakers will be announced and posted on the Summit’s website.

Members of the media are invited to attend the plenary from 9 a.m. to 1:30 p.m. in person or view the event’s livestream. Apply for credentials here. For more information, please contact [email protected].

“Science and data should drive U.S. public health research and policy​—not partisan politics or baseless conspiracy theories,” says Michael R. Bloomberg, founder of Bloomberg L.P. and Bloomberg Philanthropies, WHO Global Ambassador for Noncommunicable Diseases and Injuries, and 108th mayor of New York City. “This year’s Bloomberg American Health Summit brings leading experts to Washington to share evidence-based approaches that can improve the health of the American people.”

Through a series of on-stage conversations, keynote speakers, and videos, the event will highlight successful public health efforts and explore implications for national and state policy across the Initiative’s five focus areas: addiction and overdose; adolescent health; environmental challenges; food systems for health; and violence.

The Bloomberg American Health Initiative was created in 2016 to address the nation’s most pressing health challenges and works to improve health and life expectancy in the United States in ways that advance equity, use evidence, and change policy. The Initiative was established with a $300 million gift from Bloomberg Philanthropies to the Johns Hopkins Bloomberg School of Public Health, the world’s leading school of public health.

The Summit will also feature the work of Bloomberg Fellows, a program of the Initiative that provides world-class public health training to individuals in organizations tackling critical challenges facing the United States. Each year, the Initiative supports 60 Fellows with full scholarships to earn an MPH or DrPH degree from the Bloomberg School. Each Fellow represents an organization working on one of the Initiative’s five focus areas. The growing network of 388 Fellows and 318 collaborating organizations from 43 states, Washington, D.C., and two territories, is using the tools of public health to positively impact their own communities.

“I am thrilled that this year’s summit is bringing leading thinkers and changemakers together in our nation’s capital to discuss the future of public health policy, especially in a new administration,” says Ellen J. MacKenzie, dean of the Bloomberg School. “This is an extraordinary opportunity to spark new ideas and forge new partnerships as we work to pursue practical, achievable solutions to some of our greatest health challenges in such a historic time.”

The main plenary session on December 3 will be available to the public via livestream.

To learn more about the Bloomberg American Health Summit, please visit the Summit website.

About the Bloomberg American Health InitiativeThe Bloomberg American Health Initiative at the Johns Hopkins Bloomberg School of Public Health was developed to tackle five core issues that deeply challenge the nation’s health: addiction and overdose; adolescent health; environmental challenges; food systems for health; and violence. The Initiative’s work with faculty, Bloomberg Fellows, and collaborating organizations is building a dynamic nationwide network committed to harnessing data and developing new approaches to public health that will ensure a healthier future for all Americans. Learn more here: Bloomberg American Health Initiative.

About Bloomberg Philanthropies

Bloomberg Philanthropies invests in 700 cities and 150 countries around the world to ensure better, longer lives for the greatest number of people. The organization focuses on creating lasting change in five key areas: the Arts, Education, Environment, Government Innovation, and Public Health. Bloomberg Philanthropies encompasses all of Michael R. Bloomberg’s giving, including his foundation, corporate, and personal philanthropy as well as Bloomberg Associates, a philanthropic consultancy that advises cities around the world. In 2023, Bloomberg Philanthropies distributed $3 billion. For more information, please visit bloomberg.org, sign up for our newsletter, or follow us on InstagramLinkedInYouTubeThreads, Facebook, and X.

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‘I Don’t Feel Your Pain’: How Alcohol Increases Aggression

COLUMBUS, Ohio – Alcohol’s ability to increase people’s pain threshold is one reason that drinking also leads to more aggressive behavior, a new study suggests.

Researchers found that the less pain that study participants felt after drinking an alcoholic beverage, the more pain they were willing to inflict on someone else.

“We’ve all heard the idiom ‘I feel your pain,’” said study co-author Brad Bushman, professor of communication at The Ohio State University.

“But if intoxicated people can’t feel their own pain, they might be less likely to feel empathy when others feel pain, and that could lead them to be more aggressive.”

The study was published recently in the Journal of Studies on Alcohol and Drugs.

This study used an experimental design that has been used in research studies since 1967 and has been approved for use in humans in this study and others.

This new research involved two independent laboratory experiments, one with 543 participants and the other with 327 participants, all of whom reported consuming 3-4 alcoholic beverages per occasion at least once a month. They were recruited by newspaper advertisements and paid $75. The methods for the two experiments were identical.

After giving informed consent, participants were given 20 minutes to drink an alcohol or placebo beverage. The orange juice beverages looked identical so participants wouldn’t know which one they got.  For the placebo drinks, the researchers put a small amount of alcohol on the top of the orange juice and sprayed the rim of the glass with alcohol so that it tasted like an alcoholic beverage.

After drinking the beverage, each participant received one-second electrical shocks to two fingers on one hand. The researchers increased shocks in intensity until the participant described the shock as “painful.” That was labeled the participant’s pain threshold.

They then participated in an online competitive reaction time task in which the winner could deliver a shock to the loser. The shocks ranged from 1 (low) to 10, which was the level the participant rated as “painful.”  Participants could also choose how long the shocks lasted.

In reality, there was no opponent and the researchers randomly declared the participant the “winner” in half of the reaction time tasks. The purpose was simply to see if those who drank the alcoholic beverage would be willing to deliver stronger and longer shocks – and whether a higher pain threshold had an impact.

Results showed that for those drinking alcohol, the alcohol increased the level at which the shocks became painful to them. And the greater their tolerance for physical pain, the greater their level of aggression in terms of the intensity and length of shocks they were willing to deliver to the opponent.

Those who drank the placebo drinks weren’t as aggressive in their response, partly because their pain threshold was generally lower than those drinking alcohol, Bushman said.

“In other words, they were still able to feel their own pain – and didn’t want to inflict pain on others,” he said.

“There are many reasons that intoxicated people are more likely to intentionally hurt others, but this research suggests pain tolerance is one possible reason.”

Bushman noted that the people who drank alcohol in this study had blood alcohol concentrations averaging between 0.095% and 0.11%.  That’s slightly above the legal limit in most states, which is 0.08%.

“The effects of alcohol on pain tolerance may be higher for those who drink more than what they did in these experiments,” Bushman said. “That may make them even more willing to be aggressive against others.”

Co-authors on the study were C. Nathan DeWall of the University of Kentucky, and Peter Giancola, a licensed clinical psychologist in Montreal.

The research was supported by the National Institute on Alcohol Abuse and Alcoholism and the National Center for Research Resources.

Medicated Nasal Spray Will Slash Opioid-Related Hospital Admissions

Original post: Newswise - Substance Abuse Medicated Nasal Spray Will Slash Opioid-Related Hospital Admissions

Australian researchers say access to a free medicated nasal spray which temporarily reverses the effects of opioid toxicity while waiting for an ambulance to arrive, will save lives and reduce opioid-related hospital admissions.

The Federal Government is funding a national Take Home Naloxone (THN) program which makes the life-saving medication available for free and without prescription in pharmacies across Australia.

Naloxone reverses the effects of opioid toxicity and, under the THN program, is available from pharmacies for anyone at risk of either experiencing or witnessing an opioid overdose or adverse reaction.

Initially introduced on a trial basis, the THN program has expanded to now include more than 384 participating pharmacies across South Australia.

Dr Victoria Cock, Statewide Clinical Director, Drug and Alcohol Services SA, says demand for free naloxone is growing as more people become aware of its availability, with 8377 units being supplied across South Australia (SA) alone in 2022-23 and 16,171 in 2023-24.

A recent paper co-authored by SA Health experts and University of South Australia pharmacist Dr Jacinta Johnson found there were 2046 hospital admissions in SA involving opioid toxicity between 2017 and 2020, costing the State approximately $18 million.

Almost 20% of the patients admitted stayed in hospital for more than five days, 22% required intensive care and around 10% required mechanical ventilation.

Of the 2046 opioid toxicity-related admissions in SA hospitals, 6% involved children who were accidentally poisoned, prompting health officials to remind South Australians about the importance of safe medication storage and disposal of opioids to protect children.

Families also may wish to consider having naloxone on hand in case of an accidental poisoning at home.

Members of the public can locate their nearest registered pharmacy using the user-friendly map available on www.sahealth.sa.gov.au/naloxone. They do not need to provide any identifying details when requesting naloxone at a pharmacy. The webpage also includes a range of resources consumers may find useful.

Dr Maria Sarantou from Flinders Medical Centre says a 2019 trial of the Take Home Naloxone (THN) program, providing free access to the opioid blocker, found that it saved an estimated three lives a day.

“Research evaluating the pilot program showed that expanding THN supply to include the majority of patients prescribed medium to high doses of opioids would save hundreds of lives over the next five years,” Dr Sarantou says.

Dr Johnson, the UniSA senior lecturer who is responsible for driving all pharmacy research across SA Health, says a history of opioid toxicity is a major risk factor for future overdoses, yet many patients were not referred to drug and alcohol services or specialist pain services for help after discharge.

“There are things within the system we can improve,” Dr Johnson says.

In addition to the now implemented THN program, which is expanding to include an increasing number of public hospitals, the authors have made the following recommendations:

  • Improved discharge referrals to external healthcare services; and
  • Parental/carer education around safe storage and disposal of opioids to protect children.

Organisations involved in the study included local health networks in Adelaide, South Australian Statewide Chronic Pain Clinical Network, University of South Australia, University of Adelaide, and SA Pharmacy Statewide Clinical Support Services.

A 3-year retrospective review of hospital admissions involving opioid toxicity in South Australia” is published in Drug and Alcohol Review. DOI: 10.1111/dar.13913

Background

Naloxone is a drug that can temporarily reverse the effects of opioid toxicity, which may be referred to as an opioid overdose or adverse reaction. If someone is experiencing severe opioid toxicity, they may be unconscious or awake, but unable to talk. It’s unlikely they will be able to administer naloxone themselves.  

Naloxone can be administered by injection into a muscle or delivery through a nasal spray. It works by blocking opioid drugs, such as heroin and oxycodone, from attaching to opioid receptors in the brain. 

It is vital to call an ambulance (000) as naloxone’s effect only lasts about 30-90 minutes and the person can experience toxicity again once it wears off. 

Opioids include pharmaceutical opioids, that is, medicines used for pain, and non-pharmaceutical opioids, such as heroin. The average Australian drug-related death last year involved a middle-aged person who was taking prescribed pharmaceutical opioids in combination with other prescribed pharmaceutical drugs.

Rutgers Startup Seeks to Design Safer Prescription Opiates

Rutgers startup Zena Therapeutics strives to create narcotic medications that will minimize or even eliminate overdoses from prescription drugs.

Co-founded by Eileen Carry, PhD, and Ariane Vasilatis, PhD, the company is based on an innovation developed at Rutgers, The State University of New Jersey: a novel compound that does not increase the risk of overdose if taken with other central nervous system depressing substances such as opioids and alcohol.

“What we want to do is design medication so that even if it is misused, death is not the consequence,” said Carry. “Right now, when it comes to narcotics drugs, the onus is on the patient to take the medication as prescribed, but that is not a guarantee. We hope to shift the paradigm to substantially reduce overdose risk without compromising efficacy.”

“We believe that it is feasible and possible to design drugs and medications where death is not the end result of misuse, whether it’s accidental or on purpose as recreationally,” said Vasilatis. “We both have had family and friends succumbing to addiction and overdose, unfortunately, so we share a passion for this self-started project.”

The partnership between Carry and Vasilatis began at the lab of James Simon, PhD, a Distinguished Professor in the Department of Plant Biology at Rutgers School of Environmental and Biological Sciences. Carry’s research was focusing on safer medications for addiction and mental health, which led her to develop a proprietary compositional molecule. She asked Vasilatis to join her in entrepreneurial training with the I-Corps program at Rutgers, and from there, Zena Therapeutics was formed.

Said Vasilatis, “The I-Corps training, both at Rutgers and the national program, was paramount for us because we needed to understand: is there an end user? Is there a market for this? Or is it so niche that it would never get to that end user? I-Corps helped us realize that we had a little bit more of a niche market, but there was a broader application. Programs like I-Corps or the Yale Innovation Impact have been invaluable with all the knowledge we’ve gained and the people we’ve met through them.”

“We were able to hone our business model through participation in two National Science Foundation (NSF) I-Corps programs, the regional here at Rutgers and the national,” said Carry. “Doing the I-Corps training, where we interviewed prescribers and people from the patient demographic, we realized what a huge issue this is and that there’s a gap; nobody’s really focusing on this issue. So that motivated us to keep moving forward.”

According to the National Institute on Drug Abuse, drug overdose deaths involving prescription opioids rose from 3,442 in 1999 to over 17,000 in 2017, and has hovered around 15,000 per year since. Carry and Vasilatis believe that people with addictive tendencies may become hooked on their prescription medication, and because over 40% of U.S. adults drink alcohol while using medications, their innovation could be life-changing to many people and families.

The company’s website states that early studies with its novel compound show “favorable pharmacokinetics, robust anxiolytic activity…and favorable safety characteristics.” Carry and Vasilatis hope the compound will help both individuals suffering from general anxiety and panic disorders as well as those dealing with withdrawal symptoms.

“We’re starting with anxiety medications, specifically hoping to create alternatives for benzodiazepines, which are the current standard treatment for general anxiety and panic disorder and are commonly involved in overdoses with opiates,” said Carry. “Previously, companies have focused on the addictive potential of drugs. We understand that any psychoactive medication has addictive potential in the sense that it also has a mental component. However, none of the current medications were optimized to reduce overdose risk, and we believe we can do that without compromising efficacy. Essentially, we are creating medication with a ceiling effect, so if somebody takes the whole bottle, it won’t raise past the level of mild sedation but will still help with the anxiety.”

Vasilatis and Carry will continue to work together to lead Zena Therapeutics, which is named after the Slavic word for ‘woman’ (žena), serving as Chief Executive Officer and Chief Scientific Officer, respectively. The company has so far received funding through the New Jersey Health Foundation, the I-Corps program, $1 million in seed funding from Foundation Venture Capital Group, LLC, and a Phase I National Institutes of Health STTR (Small Business Technology Transfer) grant, the latter through which they are able to use Rutgers core services. The next step, according to Carry, is to move the compounds to clinical trials.

“It seems like whoever jumps onto the Zena Therapeutics bandwagon doesn’t leave,” laughed Vasilatis. “And everyone who has helped us has been invaluable, from Dr. Simon, who helped push us into the I-Corps program, to Dr. Nicholas Bello (at the Department of Animal Sciences) who helped us obtain our Phase I STTR, to Dr. Jacques Roberge at the Rutgers Biomolecular Innovation Cores, to Rutgers Office for Research’s Technology Transfer and New Ventures teams, who have been keeping tabs on us and sending us grant opportunities or anything they feel that can help us. Our passion is what created Zena, and Eileen’s ideas are what created the foundation for the company, but we wouldn’t have been able to move forward without this support.”

“Zena Therapeutics is another example of how Rutgers researchers focus their work on issues and questions facing the world,” said Deborah Perez Fernandez, PhD, MBA, executive director of Technology Transfer, and Vince Smeraglia, JD, executive director of New Ventures. “The opiate crisis is personal to both Drs. Carry and Vasilatis, as it is to so many people, and the Technology Transfer and New Ventures teams are proud to support them in their endeavors to solve this issue.”

Alcohol Use Identified by UTHealth Houston Researchers as Most Common Predictor of Escalated Cannabis Vaping Among Youths in Texas

Alcohol use was the most common predictor of escalating cannabis vaping among youth and young adults, independent of demographic factors, according to research by UTHealth Houston published this month in the journal Social Science & Medicine

Cannabis vaping is the use of electronic cigarette delivery of liquid tetrahydrocannabinol (THC), a concentrated form of cannabis that has been extracted and diluted into a liquid solution.Vaping cannabis has grown in popularity among young people in the U.S., according to the Substance Abuse and Mental Health Services Administration

“A decade ago, 10% of cannabis users vaped it. Now, the number is about 75%, at least for youth and young adults,” said Dale Mantey, PhD, assistant professor of health promotion and behavioral sciences at UTHealth Houston School of Public Health. “That is a major public health concern for many reasons.”

Cannabis vaping in youth and early adulthood can affect cognitive development and performance, including learning, memory, and attention; lead to the onset of chronic pulmonary damage from black market liquid THC products, as well as an increase in dependence on the drug; and result in incarceration due to federal prohibitions, which list cannabis as a Schedule I drug.

In this study, researchers focused on identifying the predictors of behavior of cannabis users and nonusers. The data included middle to high school students in Dallas/Fort Worth, San Antonio, Austin, and Houston. The students were surveyed from 2019 to 2021 and asked two questions: “Have you ever smoked marijuana or liquid THC from an electronic cigarette?” And “During the past 30 days, how many days did you smoke marijuana from an electronic cigarette?” The students were also asked to self-report their racial and ethnic identity, gender, nicotine usage, and alcohol consumption. Researchers also investigated two indicators of mental health among the student population: anxiety and depression.

“If we know what predicts that behavior, those are the things we can try to target for addressing and preventing cannabis vaping among youth,” Mantey said.

At the beginning of the study , 72.7% reported never cannabis vaping, 12.7% reported ever cannabis vaping, and 14.5% reported current cannabis vaping. Through the three-year duration of the study, the risk for cannabis vaping experimentation (never to current) was significantly higher among non-Hispanic Blacks relative to non-Hispanic whites and non-Hispanic other groups. 

Alcohol proved to be a consistent factor in those who had never vaped cannabis to begin or experiment. Researchers referred to alcohol as a “gateway” to cannabis vaping, “The ultimate goal is to delay initiation of substances in youth because the later someone initiates a substance, the less likely they are to become addicted to it,” Mantey said. “Since alcohol was shown to be a strong predictor, we need more comprehensive interventions. When we go into schools and talk about nicotine, vaping, or tobacco prevention, we need to make sure we are incorporating cannabis prevention and alcohol prevention, not just one substance.”

Depression predicted cannabis vaping initiation among Hispanics and non-Hispanic Blacks groups. The authors said more research is needed to understand the impact depression and other mental health problems may have on cannabis vaping among various demographics so public health intervention can target the most at-risk groups.

Additional UTHealth Houston authors included Stephanie L. Clendennen, DrPH, MPH; Baojiang Chen, PhD; Sana Amin, MPH; and Melissa B. Harrell, PhD, MPH.

Media inquiries: 713-500-3030

Xylazine is a New Threat That Demands Swift Action Using Lessons from the Past

BYLINE: Dr. Asif Ilyas

The emergence of xylazine in the illicit drug supply marks a new chapter in the ongoing overdose crisis. This veterinary tranquilizer, often mixed with fentanyl, poses significant risks to public health and challenges our existing strategies for combating drug abuse and overdose deaths.

Xylazine, known on the streets as “tranq,” has rapidly spread across the United States. The Drug Enforcement Administration reports that xylazine and fentanyl mixtures have been seized in 48 out of 50 states. In 2022, approximately 23% of fentanyl powder and 7% of fentanyl pills seized by the DEA contained xylazine. This widespread presence indicates a growing threat that demands immediate attention.

The dangers of xylazine are multifaceted. When combined with opioids like fentanyl, it increases the risk of fatal overdose. Xylazine can cause dangerous decreases in breathing, heart rate, and blood pressure. Unlike opioid overdoses, xylazine-related overdoses do not respond to naloxone, the standard overdose reversal medication. This complicates emergency response efforts and puts additional strain on our healthcare system.

Moreover, repeated xylazine use is associated with severe skin wounds, including open sores and abscesses. These wounds can lead to tissue death and, in extreme cases, require amputation. The medical community is still grappling with how to treat these xylazine-related injuries effectively.

As we confront this new crisis, we must learn from our experiences with the opioid epidemic. The rapid spread of xylazine mirrors the trajectory of fentanyl, which began in white powder heroin markets in the Northeast before expanding nationwide. This pattern suggests that xylazine use will likely increase and become more prevalent in the illicit drug supply.

To address this emerging threat, we need a comprehensive, multi-faceted approach. This includes increased awareness, expanded testing capabilities, and the development of targeted treatment strategies. Healthcare providers, first responders, and harm reduction organizations need to be educated about xylazine and its effects to provide appropriate care and interventions.

Research is crucial in understanding xylazine’s impact on the body, its role in the overdose crisis, and potential treatment options. The National Institute on Drug Abuse is supporting studies to explore these areas, but more resources and attention are needed.

Policymakers must also consider the regulatory landscape surrounding xylazine. While it is not currently a controlled substance under federal law, some states have begun to place it on their controlled substances lists. In Pennsylvania, Governor Josh Shapiro signed into law Act 17 of 2024, bipartisan legislation to permanently list Xylazine as a controlled substance.  A balanced approach that restricts illicit use while maintaining legitimate veterinary access is necessary.

It’s one of the reasons we are organizing the symposium “The Next Chapter of the Opioid Epidemic in Pennsylvania: The Xylazine Crisis” and making it free for medical professionals and students. By bringing together state government policymakers, physicians, and surgeons, this event will foster crucial discussions on the current state of the crisis and evidence-based treatment strategies.

As we face this new challenge, collaboration between government agencies, healthcare providers, researchers, and community organizations is essential. We must act swiftly and decisively to prevent xylazine from exacerbating the already devastating impact of the opioid crisis. By learning from past experiences and adapting our approaches, we can work towards mitigating the harm caused by xylazine and protecting public health.

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Dr. Asif Ilyas is President of the Rothman Opioid Foundation in Philadelphia, a Professor of Orthopaedic Surgery at Thomas Jefferson University, and an Associate Dean of Clinical Research at the Drexel University College of Medicine.

Study Identifies Pregnant Women at Risk for Substance Use

Study Identifies Pregnant Women at Risk for Substance Use

Study Identifies Pregnant Women at Risk for Substance Use

Original post: Newswise - Substance Abuse Study Identifies Pregnant Women at Risk for Substance Use

Study Identifies Pregnant Women at Risk for Substance Use

Racial Differences in Opioid Use Disorder

SUMMARY POINTS

  • Race influences the treatments of opioid use disorders.
  • There is an opioid crisis and a health disparities crisis.
  • Racial equity should include increasing access for treatment, funding harm reduction programs and expanding community-based services such as employment, housing, and recovery support for those with opioid use disorder. 

 

 

ANALYSIS

Background

The United States listed the opioid crisis as a public health emergency (1). Concurrently, the United States has a racial health disparities crisis that is evident as patients from various races receive different health care treatments (2). The opioid crisis has impacted all racial groups, with incidence rates of 11.9, 9.3%, and 9.6% in the White, Black, and Hispanic populations, respectively(3). 

Multiple studies have listed that racial disparities in pain treatment are associated with lower opioid use in minority patients during the beginning of liberalized opioid use in clinical settings (4). Disparities in pain treatment usually involve decreased access to medication by the patients, and biases in pain assessment and management by healthcare providers; and differential workers compensation for pain-related claims (5). A meta-analysis utilizing data from  1989-2011 found that Hispanic and Black patients had a 22% and 30% lower rate of obtaining an opioid prescription compared to white patients, respectively (5). In 2010, due to better regulation of opioid prescriptions, heroin use and other synthetically produced opioids increased, leading to a crisis of opioid related deaths (6).

Opioid Use Disorder (OUD) is the chronic use of opioids that leads to habitual drug seeking and includes reduced self-control, participation in risky behavior and social impairments (7). Although treatment for OUD, discrimination continues to affect the care provided to the minority population (7). It is known that treatment for OUD can reduce the overdose rate, increase patient involvement in addiction programs when discharged and decrease overall health care utilization (8). Unfortunately, communities that have a higher number of Black and Hispanic residents have reduced health care resources that can provide the recommended interventions for OUD. When controlling for factors such as overdose burden, socioeconomic status and hospital risk factors; minority communities are still less likely to have access to essential harm reduction services(8). 

FIGURE 1: U.S Drug Overdose death rate 

[SEE ARTICLE from the CDC]

 

Analysis

Only 20% of patients with OUD get treatment despite the studied benefits such as reduced risk of mortality (10). Research has shown that racial minorities are less likely to obtain treatment for OUD from health care providers when compared to white counterparts(8). In 2019, Black and Hispanic with diagnosed OUD were 30% less likely than White patients to be offered treatment (11). 

There have been numerous public strategies taken to improve opioid misuse. Unfortunately, public health campaigns primarily focus on White communities and ultimately decreased the rate of OUD and opioid related death for White patients alone rather than the combination with minority patients (12). As a result of minority patients receiving less community support and resources for OUD, individuals resort to self-medicating with fentanyl and heroin which increases opioid misuse within these populations (12). In 2019, opioid related mortality rates decreased by 0.3% in White patients but increased by 20% in Black patients (13). 

A quantitative analysis on the intersection of race and opioid use disorder treatment observed how race influences treatment for OUD. This study used patient information from the Treatment Episode Data Set Discharges (TEDS-D), a nationwide study utilizing data of patients discharged from substance use disorder (SUD) treatment programs (14). The dataset includes information on treatment episodes and admissions to SUD treatment programs including programs in public and privately owned facilities. TEDS-D also included information from institutions such as state prisons. The study only used information from patients with a DSM-IV diagnosis of OUD between 2013 to 2017. From this data, researchers observed that being a minority is linked with a reduced chance of being referred to treatment by a healthcare worker. Data also showed that compared to their White counterparts, minority patients had a reduced likelihood of receiving appropriate OUD medication as part of the treatment plan. This study, as with many others, concluded that change is required to address this problem. This study primarily focused on policymakers and how to implement these findings to create interventions for OUD that acknowledge race. Public health interventions could help to address the discrepancies in treatment gaps that this study identified.

Discussion

Additional studies are needed to develop more efficacious strategies to address race for OUD. Across multiple studies, it is noted that areas with more economic instability and distress reported higher drug use. There are other factors discussed such as income, housing instability, transportation, insurance, biases, and mistrust in the healthcare system that influence access to treatment. Interventions in the local, state, and national policy levels are critical to tackle these issues. 

Interventions such as linkage and retention in care while not criminalizing patients with OUD and access to treatment and harm reduction services are beneficial in minority communities. Ultimately, intervention and prevention strategies must include evidence based and culturally receptive tools that use social determinants of health to reduce biases surrounding treatment. These tools include culturally targeted campaigns and hiring community prevention liaisons or ambassadors to assist with decreasing mistrust and increasing accessibility to treatment and reduction services. Opioid misuse is preventable. Integrating efforts with an emphasis on childhood experiences that increase the risk for OUD, as well as applying trauma-informed care, is essential for improving minority communities that have been affected by years of discriminatory policies. 

 

 

 

 

 

 

Exposure to Marijuana in the Womb May Increase Risk of Addiction to Opioids Later in Life, Study Finds

Newswise — University of Maryland School of Medicine Researchers Identify Neurobiological Changes Leading to Increase Release of the Brain Chemical Dopamine and Its Target Neurons Linked to Addiction-Like Behavior 

With the increased legalization of recreational cannabis, as many as 1 in 5 pregnant women in the U.S. are now using the drug to help with morning sickness, lower back pain or anxiety. Evidence has been growing, however, to suggest that tetrahydrocannabinol (THC), the main psychoactive ingredient in cannabis, poses risks to the developing fetus by impacting brain development. Now a new study finds that this could increase the risk of addiction to opioids later in life.  

The preclinical animal study, led by researchers at the University of Maryland School of Medicine, was published in the journal Science Advances. It found that prenatal exposure to THC causes a rewiring of the fetal brain.  THC caused certain brain cells, called dopamine neurons, to respond in a hyperactive way, causing a heightened increase in dopamine release.  This was accompanied by heightened neuronal responsiveness to cues associated with rewards like a light turning on to indicate that food or an opioid drug was available.

“Doctors are contending with an explosion of cannabis use, and the THC content has quadrupled from what it was a generation ago,” said study corresponding author Joseph Cheer, PhD, a Professor of Neurobiology and Psychiatry at the University of Maryland School of Medicine. “It demonstrates the enduring consequences that prenatal cannabis exposure exerts on the brain’s reward system, which ultimately results in a neurobiological vulnerability to opioid drugs.”

The American College of Obstetricians and Gynecologists recommends that doctors counsel patients on concerns about potential adverse health consequences of continued use of cannabis during pregnancy. Dr. Cheer and others doing research on THC exposure during pregnancy are racing to learn more about the health consequences on developing fetuses to help doctors better counsel their patients on the drug’s effects.

To conduct this new study, he and his colleagues found that fetuses exposed to a moderately low dose of THC (equivalent to their mothers smoking one to two joints per day) developed changes in how their reward system functioned, causing them to develop an at-risk phenotype for opioid seeking. Animals previously exposed to THC in utero display a dramatically increased motivation to press a lever that would deliver a dose of opioid drugs compared to those that were not previously exposed to THC. 

When THC-exposed animals reached early adulthood, they were more likely to show enhanced opioid-seeking and were more likely to relapse upon opioid-associated environmental cues compared to those animals who were not exposed to THC in the womb. They were also more likely to develop persistent addiction-like behaviors.

In a follow-up experiment, the researchers implanted tiny sensors in the animals’ brains and measured heightened dopamine release, accompanied by activity in neurons that over-represented opioid-related cues, in the rats exhibiting strong addiction-like behaviors.

“These observations support the hypothesis of a hypersensitized ‘wanting’ system that develops in the brain after exposure to THC during prenatal development,“  said Dr. Cheer. “Interestingly, we found that this opioid-seeking phenotype occurs significantly more in males compared to females, and we are currently performing research with our colleagues at UMSOM, to determine why this is the case.” 

Dr. Cheer’s previous work published in the journal Nature Neuroscience found prenatal exposure to THC makes the brain’s dopamine neurons hyperactive, which may contribute to an increased risk of psychiatric disorders like schizophrenia. His work has been independently verified by three independent laboratories throughout the world.

Along with his colleague Mary Kay Lobo, PhD, Professor of Neurobiology at UMSOM, Dr. Cheer serves as the co-director of the Center for Substance Use in Pregnancy, which is part of UMSOM’s Kahlert Institute for Addiction Medicine. The two are working with a team of researchers to investigate the enduring effects of drug and alcohol exposure in the womb.

“We need to more fully understand the enduring effects of THC exposure in the womb and whether we can reverse some of the deleterious effects through CRISPR-based gene therapies or repurposed drugs,” said UMSOM Dean Mark T. Gladwin, MD, who is the John Z. and Akiko K. Bowers Distinguished Professor and vice president for medical affairs at the University of Maryland, Baltimore. “We also need to provide better advice to pregnant patients, many of whom are using cannabis to help control anxiety because they think this drug is safer for their baby than traditional anti-anxiety medications.”  

The study was funded by the National Institute on Drug Abuse (Grant: R01 DA022340)  (Grant: K99 DA060209).  UMSOM faculty member Miguel A. Lujan, PhD, a research associate in Neurobiology, was the first author of the paper. 

About the University of Maryland School of Medicine

Now in its third century, the University of Maryland School of Medicine was chartered in 1807 as the first public medical school in the United States. It continues today as one of the fastest growing, top-tier biomedical research enterprises in the world — with 46 academic departments, centers, institutes, and programs, and a faculty of more than 3,000 physicians, scientists, and allied health professionals, including members of the National Academy of Medicine and the National Academy of Sciences, and a distinguished two-time winner of the Albert E. Lasker Award in Medical Research. With an operating budget of more than $1.2 billion, the School of Medicine works closely in partnership with the University of Maryland Medical Center and Medical System to provide research-intensive, academic, and clinically based care for nearly 2 million patients each year. The School of Medicine has more than $500 million in extramural funding, with most of its academic departments highly ranked among all medical schools in the nation in research funding. As one of the seven professional schools that make up the University of Maryland, Baltimore campus, the School of Medicine has a total population of nearly 9,000 faculty and staff, including 2,500 students, trainees, residents, and fellows. The School of Medicine, which ranks as the 8th highest among public medical schools in research productivity (according to the Association of American Medical Colleges profile) is an innovator in translational medicine, with 606 active patents and 52 start-up companies. In the latest U.S. News & World Report ranking of the Best Medical Schools, published in 2023, the UM School of Medicine is ranked #10 among the 92 public medical schools in the U.S., and in the top 16 percent (#32) of all 192 public and private U.S. medical schools. The School of Medicine works locally, nationally, and globally, with research and treatment facilities in 36 countries around the world. Visit medschool.umaryland.edu