Association of Medicaid Expansion With Opioid Overdose Mortality in the United States

Kravitz‐Wirtz, Nicole; Davis, Corey S.; Ponicki, William R.; Rivera‐Aguirre, Ariadne; Marshall, Brandon D. L.; Martins, Sílvia S.; Cerdá, Magdalena

doi:10.1001/jamanetworkopen.2019.19066

Cited by 75 publications

(36 citation statements)

References 31 publications

(96 reference statements)

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“…Accordingly, the suitability for organ donation of an individual decedent captured by CALC methodology cannot be ascertained. Despite this, however, death certificate‐based assessments have been proven to be robust and serve as the backbone of population‐based health and disease assessments in a variety of fields, 26‐28 and have long been accepted as a basis for estimating donor potential 8,29 . CALC deaths in particular have been shown to correlate well with other measures of donor potential without suffering from the same cost and practicability considerations 7 .…”

Section: Discussionmentioning

confidence: 99%

Results of a data-driven performance improvement initiative in organ donation

Doby

Hanner

Johnson

et al. 2021

American Journal of Transplantation

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New metrics for organ procurement organization (OPO) performance utilize National Center for Health Statistics data to measure cause, age, and location consistent (CALC) deaths. We used this denominator to identify opportunities for improved donor conversion at one OPO, Indiana Donor Network (INOP). We sought to determine whether such analyses are immediately actionable for quality improvement (QI) initiatives directed at increased donor conversion. CALC‐based assessment of INOP’s performance revealed an opportunity to improve conversion of older donors. Following the QI initiative, INOP donor yield rose by 44%, while organs transplanted rose by 29%. These changes tolerated temporary disruption around the COVID‐19 pandemic. Improved donor yield was primarily seen in older groups identified by CALC‐based methods. Process changes in resource allocation and monitoring were associated with a 57% increase in the number of potential donors approached in the QI period and a subsequent rise in the number of potential donor referrals, suggesting positive feedback at area hospitals. Post‐intervention, INOP’s projected donation performance rose from 51st to 18th among all OPOs. OPOs can use CALC death data to accurately assess donor conversion by categories including age and race/ethnicity. These data can be used in real time to inform OPO‐level processes to maximize donor recovery.

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Section: Discussionmentioning

confidence: 99%

Results of a data-driven performance improvement initiative in organ donation

Doby

Hanner

Johnson

et al. 2021

American Journal of Transplantation

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“…However, it seems illogical to imply that the solution to the epidemic is to reduce health insurance coverage for millions of Americans. Moreover, recent research suggests that Medicaid expansions under the ACA reduced deaths from overdoses (Kravitz-Wirtz et al 2020).…”

Section: The Real Causes Of the Opioid Epidemic And Policy Responsesmentioning

confidence: 99%

The Opioid Epidemic Was Not Caused by Economic Distress but by Factors That Could Be More Rapidly Addressed

Currie

Schwandt²

2021

The ANNALS of the American Academy of Political and Social Scie

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Without the opioid epidemic, American life expectancy would not have declined prior to 2020. The epidemic was sparked by the development and marketing of a new generation of prescription opioids, and the behavior of opioid providers is still helping to drive it. Little relationship exists between the opioid crisis and contemporaneous measures of labor market opportunity: cohorts and areas that experienced poor labor market conditions do show lagged increases in opioid mortality, but the effect is modest relative to the scale of the epidemic. We argue that specific policies and features of the U.S. health care market, especially liberal prescribing of opioids, led to the current crisis. It will not be possible to quickly reverse depressed economic conditions, but it is possible to implement policies that would reduce the number of new opioid addicts and save the lives of many who are already addicted.

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“…The opioid epidemic has long entered the public consciousness. Three hundred eighty-three thousand and ninety-one deaths from overdose in the US during 2001 to 2017 has punctuated this awareness ( 1 ). Despite a greater appreciation of these ramifications, the prescription of opioids for chronic pain continues.…”

Section: Introductionmentioning

confidence: 99%

The Effects of Low Dose Naltrexone on Opioid Induced Hyperalgesia and Fibromyalgia

et al. 2021

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Objectives: While opioids temporarily alleviate pain, the overshoot of balancing pain drivers may increase pain, leading to opioid induced hyperalgesia (OIH). Our goal was to find out what chronic opioid treatment does to pain tolerance as measured by the cold pressor test (CPT), an objective measure of pain tolerance, and to find an alternative effective treatment for chronic pain and FM.Materials and Methods: The setting was an academic addiction medicine service that has an embedded pain service. Patients had routine clinical care starting with an evaluation that included assessment of medical and psychiatric conditions. Participants were 55 patients with OIH and 21 patients with fibromyalgia; all had at least two CPTs. Treatment included a single dose of buprenorphine for detoxification. In this open-label case series, patients were treated with low dose naltrexone (LDN), a pure opioid receptor antagonist that, we hypothesize, treats OIH and FM by restoring endogenous opioid tone.Results: Comparing initial and last CPT times, those with OIH more than quadrupled their pain tolerance, and those with FM doubled theirs. This improved pain tolerance for OIH and FM was statistically significant (p < 0.0001 and p = 0.003, respectively) and had a large effect size (r = 0.82 and r = 0.63, respectively).Discussion: Results suggest that patients on chronic opioid therapy should have pain tolerance measured by CPT with detoxification and LDN provided to correct opioid induced hyperalgesia if found. FM may also be treated with LDN. The main limitation of the findings was lack of a randomized control group treated with placebo.

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Association of Medicaid Expansion With Opioid Overdose Mortality in the United States

Cited by 75 publications

References 31 publications

Results of a data-driven performance improvement initiative in organ donation

Results of a data-driven performance improvement initiative in organ donation

The Opioid Epidemic Was Not Caused by Economic Distress but by Factors That Could Be More Rapidly Addressed

The Effects of Low Dose Naltrexone on Opioid Induced Hyperalgesia and Fibromyalgia

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