In recent years the phenomenon of boarding psychiatric patients in emergency departments has not only become a nationwide problem but a growing problem here in North Carolina. Psychiatric boarding refers to the phenomenon of patients with primary behavioral health complaints experiencing excessive waiting times in emergency departments (EDs). Many claim that the root of this problem arises from the continued cutting of funding for psychiatric institutions. Currently, North Carolina falls below the national average with the number of available inpatient psychiatric beds and ranks 40th number of beds per person in the country. An addition, the average wait time for a patient with a psychiatric compliant to be either discharged or be admitted is 2.5 days. This number is even worse for individuals who are waiting to be admitted to an inpatient bed at one of the psychiatric hospitals in the state, patients wait almost 4 days. How do we go about fixing this problem? This is a question that psychiatrists, policymakers and mental health professionals are striving to answer but with limited funding from the state it is challenging to do so.
As the temperatures begin to rise and the sun starts to shine means many of us will be flocking to the nearest body of water whether that’s the neighborhood pool or the breezing beach. As I am getting ready for my beach weekend, I head to the nearest drug store to stock up on all the essentials: diet coke, snacks, trashy tabloids and of course sunscreen. I always look dumbfounded in the sunscreen aisle since there are so many to pick from and how do you know which one works best? For those with fair skin like me I burn fairy quickly after being in the sun so I’m always looking for the highest SPF to protect my skin. Many dermatologists such that any SPF over 50 doesn’t significant protect much more against UVA/UVB rays and folks using the higher SPF sunscreens and feel more protected and therefore don’t practice other protective behaviors such as wearing hats and seeking shade. However, there is a new mineral that provides your skin an additional layer of protection, zinc oxide. Zinc oxide provides a physical barrier between your skin and the sun and deflects the sun off your skin while traditional sunscreens absorb the rays. So next time you are purchasing sunscreen make sure to check out those with zinc oxide!
In a research letter published by the Journal of the American Medical Association, researchers noted that overdose deaths from synthetic opioids, such as fentanyl, surpassed prescription opioids and heroin as the leading cause of overdose deaths in the United States. There has been an increasing trend of fentanyl and other synthetic opioids being found in illicit supplies of heroin, cocaine, methamphetamine, and other drugs. Utilizing data from the National Vital Statistics based on death certificates including information on all deaths in the US, Jones et al were able to examine overdose related deaths. While there has been an increasing trend in the number of opioid overdose deaths, previously these have been primarily related to prescription opioids. Of the 42,249 opioid related overdose deaths that occurred in 2016, Jones et al found that 19,413 involved synthetic opioids, while 17,087 involved prescription opioids, and another 15,469 involved heroin. Of the 19,413 deaths related to synthetic opioids, the majority (79.7%) involved another drug or alcohol, with the most common being another opioid. There are some limitations regarding the completeness of data, and the authors suggested that the increase may be due to an increase in testing for synthetic opioids. Still, this data paints a startling picture of the state of the opioid epidemic, showcasing a need to move beyond prescribing habits in order to reduce overdose deaths.
Jones CM, Einstein EB, Compton WM. Changes in Synthetic Opioid Involvement in Drug Overdose Deaths in the United States, 2010-2016. JAMA 2018;319(17):1819-1821. doi:10.1001/jama.2018.2844.
In response to the Opioid Epidemic currently being faced in North Carolina and the US, several local jurisdictions have taken steps towards legal action against the manufacturers and distributors of prescription opioids. Over four hundred federal lawsuits have emerged from local governments across the country, and these have been consolidated into a lawsuit in Ohio.
Yesterday, the City Council of Greensboro voted to join a nationwide lawsuit that targets manufacturers and distributers of prescription opiate painkillers. Later this week, the Davidson County Board of Commissioners will have a hearing and presentation around joining national opioid litigation. In total, more than forty of the State’s 100 counties have joined the lawsuit. In Forsyth County, containing the city of Winston-Salem, a similar lawsuit was filed that included defendants of more than 20 drug manufacturers.
Many of these local jurisdictions cited that the risks for addiction and dependency to prescription opiates were never communicated by drug companies, while manufactures continued to make profits with increasing supply and demand. As more municipalities continue to join litigation of file new lawsuits, while trying to adopt laws and policies to limit overprescribing, further attention should be paid to find and utilize effective strategies to limit opioid overdose deaths.
News & Record: Greensboro joins lawsuit against drug manufacturers over opioid epidemic – http://www.greensboro.com/news/government/greensboro-joins-lawsuit-against-drug-manufacturers-over-opioid-epidemic/article_22ff745e-2002-5c27-a41a-454ab80403b7.html
Winston-Salem Journal: Forsyth County sues opioid manufacturers, distributers, claiming deceptive marketing practices – http://www.journalnow.com/news/local/forsyth-county-sues-opioid-manufacturers-distributors-claiming-deceptive-marketing-practices/article_7f8a2bf3-958f-5462-b63b-4c1affeca27d.html
The Dispatch: County to hear opioid litigation presentation – http://www.the-dispatch.com/news/20180430/county-to-hear-opioid-litigation-presentation
Earlier today, The News & Observer reported that thousands of doctors in North Carolina were breaking the recently passed STOP Act, by over-prescribing prescription opioids. In a previous post I briefly explained provisions under the STOP Act, STOP Act: Implementation and Effects on the Opioid Epidemic in North Carolina.
Based on preliminary data from the North Carolina Department of Health and Human Services, and Blue Cross and Blue Shield, showed that many were over-prescribing. The STOP Act limits opioid prescriptions to five days to first time patients, or seven days if the patient had surgery. The state health department presented their findings to staff of the North Carolina Medical Board, who noted that they do not have the capacity to investigate every prescriber reported to determine if prescriptions were legitimate.
Blue Cross and Blue Shield had started to electronically block the filling of prescription opioids for more than seven days at the start of April, noting that this policy had blocked more than 1,100 prescriptions. While there were questions about the precision of the data and its accuracy, these preliminary reports showcase the difficulties of challenging the opioid epidemic by policies limiting prescribing.
The News & Observer – Thousands of N.C. doctors are over-prescribing opioids, breaking a new state law – http://www.newsobserver.com/news/business/article209824434.html
Blue Cross and Blue Shield Institute has started a partnership with the ride sharing company Lyft to provide their members with free rides to pick up their medications. The Blue Cross Blue Shield Institute is a new organization that’s mission is to reduce the barriers of accessing healthcare. One of the largest identified barriers to accessing healthcare is transportation. Last year, their big initiative was a similar program with Lyft to provide free transportation for their patients to their doctors’ appointments. By investing in these types of programs, the organization is hoping to reduce costs in the long -term and improve the health outcomes of their consumers. With this newest imitative they are also partnering with pharmaceutical organization such as CVS Health and Walgreens to increase medication adherence. These programs are still under pilot testing and are currently funded by CVS and Walgreens in Chicago and Pittsburgh with patients who are living in “transportation deserts”. These types of unique partnerships are allowing for creative solutions and addressing the social determinants of health in order to solve the most dire healthcare problems. Let’s hope to see more of these types of collaborations in the future.
Illegal drug use has been a major topic of concern throughout the 21st century. In the mid-1980s, we saw an emergence of harsh federal penalties for illegal drug users and strong war-on-drugs messaging. Today, we are seeing increased attention given to illegal opioid use as a public health concern. While today’s efforts largely focus on helping illicit drug users overcome addiction, drug testing is now being considered as a requirement for participation in food assistance programs.
The Associated Pressed announced earlier this month that the Trump administration “is considering a plan that would allow states to require certain food stamp recipients to undergo drug testing.” These plans could require a negative drug test before receiving aid through programs like the Supplemental Nutrition Assistance Program (SNAP), a program which provided food assistance to over 40 million people in January 2018 alone (1). While a war-on-drugs approach has been used to criminalize individuals who suffer from addiction, states, including SC, GA, AL, and FL, have consistently ruled that drug testing as a requirement for participation in assistance programs unconstitutional. In Lebron v. Florida Department of Children and Families, the state established that the government does not have bases for suspicionless drug testing among recipients of the Temporary Assistance for Needy Families program and that such requirements are unconstitutional.
In my opinion, this requirement would unnecessarily portray welfare recipients as drug abusers who are undeserving of assistance. I am curious to learn more about this current administrations’ cause for the drug testing requirement. Would testing encourage drug users who need assistance to stop using drugs? Is the requirement meant to reduce federal spending? How will drug test be funded when programs such as SNAP cost over $64 billion in 2017 alone (2)? Would assistance programs offer resources to people who fail drug tests?
Reference: 1) https://fns-prod.azureedge.net/sites/default/files/datastatistics/january-performance-report-2018.pdf
Late last week, classified ad website Backpage.com went offline after being seized and disabled due to an “enforcement action by the Federal Bureau of Investigation, the U.S. Postal Inspection Service, and the Internal Revenue Service Criminal Investigation Division”. Backpage.com is known for personal ads, and was considered by many to be the dominant online platform for sex workers to advertise their services.
Various websites have been shutting down their personal ads section in response to the Stop Enabling Sex Trafficking Act (SESTA), which has taken aim at online platforms as a playing a perceived role in sex trafficking and prostitution. While many advocates have been fighting SESTA for a large part of the year, awareness seems to be low of the laws implications among the general population.
Advocates against SESTA argue that the act will do more harm than good in regards to the safety of sex workers. Online platforms for sex work have been viewed as safer than street based sex work, allowing for screening of potential clients. Others have argued that SESTA would limit online free speech, arguing that it would require platforms to put strong restrictions on users’ speech, extending beyond the space of personal ads. If you’re interested in seeing what you can do stop SESTA, check out https://stopsesta.org for more information on how to contact your elected officials.
Sources – Buzzfeed News: Backpage Has Been Taken Down By The US Government And Sex Workers Aren’t Happy – https://www.buzzfeed.com/blakemontgomery/backpage-service-disruption?utm_term=.mceyodXp#.bkjAQmNK
Misinformation is easy to spread. I’d bet money we have all witnessed this phenomenon on social media. Let’s look back for a second to before these digital platforms arrived—the days of primary school gossip. You have visions of four square (not the app) and Lunchables, enviable amounts of free time and the all-classmates invited birthday parties? We told each other some weird tales. Our imaginations were churning, I don’t blame us. Now imagine giving the kid who claimed to be able to do ten mid-air flips off the diving board a microphone. And then another kid, or maybe even teacher, turns on the overhead PA system and broadcasts what the kid with the microphone is saying to the whole school. The information this prolific diver is claiming doesn’t change but it sure spreads faster, further, and seems a lot more official when amplified by technology (is audio equipment technology, for this metaphor I say, “yes”). Enter social media and ubiquitously referred to “fake news.”
And it’s like a pyramid scheme—no one thinks they’re the one getting duped. How can that be the case? What can we, both as health communicators and as information consumers, do about it? Here are some key concepts to whet your whistle: third-person effect, Spinoza, relationship currency. Those are some interest-piquing words right there.
Give a read to “Why we lie to ourselves and others about misinformation” by Dr. Southwell (who is the social marketing course instructor to two of this here blog’s bloggers, and who also just led an insightful guest lecture which Casey will tell you all about later in the week). If/when inspiration strikes, submit your ideas for the Rita Allen Foundation’s Misinformation Solutions Forum.
In an article published yesterday by BuzzFeed News, it was released that Gay Dating App Grindr has been sharing its users’ HIV status with two outside companies, a move which many consider dangerous to the queer community that the app claims to serve.
The sites, Apptimize and Localytics, work with Grindr to optimize the app and user experience. While it has been noted that these companies do not share information with third parties, there are still concerns with the sharing of sensitive information of a historically vulnerable population. This could raise flags for users sharing their HIV status on the app, which could negatively impact public health interventions that work to reduce HIV transmission and stigma.
Grindr recently announced that they would remind users to get tested for HIV every three to six months, offering a cue to action for users to be more aware of their HIV status. Knowing ones status is a crucial component for reducing the number of new HIV infections, such as by offering the opportunity to those who are living with HIV to be connected to care and achieve viral suppression.
BuzzFeed News: Grindr Is Sharing The HIV Status Of Its Users With Other Companies –https://www.buzzfeed.com/azeenghorayshi/grindr-hiv-status-privacy?bfsplash&utm_term=.eu9v16ZaQ#.akvOQgNJj