Medication for Opioid Use Disorder (MOUD), sometimes referred to as Medication-Assisted Treatment (MAT), is a life-saving, evidence-based treatment method considered the gold standard for addressing opioid use disorders. Unfortunately, however, there are a number of barriers — both legal and cultural — that prevent some patients from accessing the treatment they need.
MOUD combines the use of prescription medications (like buprenorphine, methadone, and naltrexone) with counseling and behavioral therapies to provide comprehensive treatment in an inpatient or outpatient setting.
Due to stigma toward MOUD from patients and providers, as well as an overall lack of providers certified to dispense MOUD, there are currently more prescribing rules in the U.S. for the drugs used in MOUD, like buprenorphine, than for opioids. Major legal barriers include provider limits on the number of patients to whom they can offer MOUD, restrictions on which facilities can provide in-patient MOUD treatment, and insurance pre-authorization requirements.
In 2017, more than 47,000 people had died of an opioid overdose, and 2 million people were dependent on opioids. This astonishing number is attributable in part to the lack of federal and state legislation to curb the over-prescription of opioids.
Opioids first entered the US market in the late 1990s. Pharmaceutical companies’ assured physicians that opioids were less addictive than morphine and posed less dangerous side effects, and doctors began prescribing the pills at unprecedented rates.
Understanding how the dearth of federal and state legislation, coupled with prescribing patterns based on race and socioeconomic status, influence the over-prescription of opioids can potentially lead to new and innovative ways of solving the opioid epidemic that continuously threatens the United States.
As the United States continues its response to a seemingly inevitable coronavirus epidemic, experts in law and public health are stressing the importance of supportive social safety nets to ensure an equitable and fair response to the virus’s spread.
If you are one of the nearly two million Americans who works for minimum wage, for much of the service industry, or in the contingent labor force, a situation that forces you to stay home from work – because of illness, or government- or self-imposed quarantine or social distancing measures – could create dire financial circumstances and inhibit measures to mitigate the impact of an infectious disease like COVID-19.
The landscape of abortion law in the United States saw increases in targeted restrictions in 2019, but also some efforts to protect access by state governments and courts, according to new data published this week to LawAtlas.org.
The data capture abortion-focused statutes and regulations (or amendments to existing laws) in effect between December 1, 2018 and December 1, 2019, as well as court cases that may impact the implementation of these laws.
Just last year, one in five high school students and one in 20 middle school students across the country used electronic cigarettes (e-cigarettes). According to the 2018 National Youth Tobacco Survey, more than 3.6 million middle and high school students used electronic cigarettes, more than double the number of youth using e-cigarettes in 2017. This increase is concerning given what is known about the adverse health effects of e-cigarettes. Recent research shows that nicotine has a negative effect on the developing brain. Other chemicals found in e-cigarettes are toxic to cells and have been linked to cardiovascular and lung diseases, including cancer.
Diverse strategies have emerged to curb the youth e-cigarette epidemic, including million-dollar campaigns from CVS Health and school policies implementing random nicotine testing. Most notable is the recent ordinance passed by San Francisco, the first city to institute a large-scale sales restriction. The city-wide ban prevents residents from purchasing any e-cigarettes in stores or online until products have undergone a premarket review by the U.S. Food and Drug Administration (FDA). The ban is motivated in part to decrease youth access to e-cigarettes. From 2016 to 2017, current e-cigarette use among California high school students increased from 8.6% to 10.9%, according to the California Student Tobacco Survey.The San Francisco ban is not the first law implemented to impact youth access to e-cigarettes. California state law sets various online purchasing requirements for e-cigarettes: online purchasers must provide proof of age, distributors must deliver to verified mailing addresses, and online purchaser age must be verified by a third-party service. These laws were in place in 2016 and 2017, but it is unclear whether these state laws had any impact on the 2.3% increase in youth vaping because, problematically, there is no current research exploring the link between the laws and youth e-cigarette use.
Inclusionary zoning (IZ) laws are one such approach, and are intended to create affordable housing through collaboration between public and private developers. These laws create requirements and incentives for developers, such as unit size minimums and establishing income eligibility criteria. IZ laws counter preceding ‘exclusionary zoning’ policy where large-lot zoning is used to prevent low-income integration into rising developments. Contrary to the original intent, IZ laws have been criticized for creating potential financial disincentives to develop in low-income areas and increasing housing price inflation.
To combat this risk, states like New Jersey, Massachusetts, and California have added additional incentives such as density bonuses, expedited approvals, and fee waivers. These have been presented to developers as part of state ordinances and regulations. Under its Affordable Housing Act, Illinois seeks to create grants, mortgages, and loans to rehabilitate, develop, operate, and maintain housing for low-income and very-low-income families. The Act requires local governments to create affordable housing plans based upon their municipalities’ median incomes. For example, based upon population median incomes and housing values, the town of Evanston, Illinois is required to provide 4,993 affordable housing units to accommodate its population of 75,472 who have an area median income of $63,327.
The Cook County Health Department in Illinois just published a dataset to LawAtlas.org as part of a yearlong legal epidemiology project funded by the CDC Public Health Law Program and ChangeLab Solutions. The health department created a policy surveillance dataset tracking IZ laws in 10 municipalities across the country, concentrating on residential areas around Cook County and the Chicago Metropolitan area: Boulder, Colorado; Burlington, Vermont; Cambridge, Massachusetts; Evanston, Illinois; Highland Park-Lake County, Illinois; Irvine, California; Lake Forest-Lake County, Illinois; San Diego, California; Santa Fe, California; Stamford, Connecticut.
One common provision of IZ policies are set-asides. These are ordinances that require developers to reserve a portion of the new development for low-income residents. Through its policy surveillance project, the health department found that nine of the jurisdictions have implemented mandatory IZ policies and six jurisdictions have established preferences for who can live in set-aside units. The percentage of set-aside required for low-income housing varies by jurisdiction – from 10 percent in two jurisdictions, up to 25 percent in one. Of the 10 jurisdictions studied, one (Stamford, Connecticut) doesn’t require any set-aside, and nine allow for alternatives to set-asides, such as fee-in-lieu (nine jurisdictions), land dedication (six jurisdictions), and alternative proposals (four jurisdictions). For those jurisdictions with fee-in-lieu alternatives, seven provide those payments to Affordable Housing Funds.
While extensive literature provides evidence for a positive association between levels of wealth in an area and the levels of health in that area, more research is needed to establish the efficacy of IZ laws. Governments are increasingly implementing relevant policies to combat the negative effects of gentrification and IZ policies could be part of the mix, particularly when used in conjunction with efforts to preserve existing community culture beyond property interest, as neighborhoods provide important social support networks for residents. “Revitalization without displacement” is a rising standard for preserving the positive economic benefits of gentrification without destroying communities through displacement. This policy advocates increasing the total population by filling vacancies and increasing housing densities and preserving community bonds. Experts consider ‘social mix’ to be a common good.
The ten policies in this dataset are just the tip of the iceberg, but they do offer an interesting, important look into the complexity and variation of these laws.
A health care environment already rife with navigational challenges for immigrant communities likely just became much more complicated and more dangerous even after planned US Immigrant and Customs Enforcement (ICE) court-ordered arrests and deportations this past Sunday, July 14, in 10 major U.S. cities never really materialized.
News articles from New Jersey to California detail immigrant communities on high alert, with many members of those communities fearing to go out in public. As the LA Times reports, whether this self-induced quarantining is a “one-day shift” or whether it will continue remains to be seen, but it is likely one will further harm immigrant populations, particularly Latinx and Hispanic communities. The planned (though largely uneventful ICE raids) are authorized by the Immigration and Nationality Act, which was amended in 1996 to include the Illegal Immigration Reform and Immigrant Responsibility Act, including section 287(g). Read More
Alabama, Georgia, and Ohio have passed laws in recent weeks that ban many, if not all, abortions in their state. These bans are the latest additions to the litany of laws and policies that severely limit or totally prevent access to abortion for women in the United States.
“Fetal heartbeat” bans, like those enacted in both Ohio and Georgia, are some of the most restrictive types of gestational limitations on abortion in the U.S. They prohibit abortion at the point a fetal heartbeat is detectable by ultrasound—as early as six weeks’ gestation. This is often a point before many discover they are pregnant. Ohio and Georgia are not the first states to have enacted fetal heartbeat bans, however, and current legislative trends suggest they will not be the last. In 2019 alone, lawmakers have proposed heartbeat bans in at least 14 other state legislatures. Read More
Exclusionary school discipline (ESD) policies, also known as Zero Tolerance policies, enforce disciplinary measures like suspension, expulsion, or law enforcement referral to address particular student behaviors.
Though it began as part of the Gun-Free Schools Act of 1994, which mandated one-year expulsion for possessing a firearm at school, ESD became more widely adopted over time. Now, the policies apply nationwide to a broad range of behaviors — from damaging property and fighting, to possessing a cell phone or tobacco, as well as behaviors described by subjective terms often undefined in the law, like willful defiance, obscenity, or profanity. Read More