Assessing experts' perspectives on challenges in substance misuse prevention, harm reduction, and treatment to shape funding priorities in New York State.

BACKGROUND: Drug overdose is a leading cause of death and opioid-related deaths increased by more than 300% from 2010 to 2020 in New York State. Experts holding a range of senior leadership positions from across New York State were asked to identify the greatest challenges in substance misuse prevention, harm reduction, and treatment continuum of care. Expert input was used to shape funding priorities. METHOD: Individual semi-structured interviews of sixteen experts were conducted in April and May 2023. Experts included academics, medical directors, leaders of substance misuse service agencies, administrators of a state agency, a county mental health commissioner, the president of a pharmacy chain, and a senior vice president of an addiction-related national non-profit. Zoom interviews were conducted individually by an experienced qualitative interviewer and were recorded, transcribed, and coded for content. An initial report, with the results of the interviews organized by thematic content, was reviewed by the research team and emailed to the expert interviewees for feedback. RESULTS: The research team identified five major themes: 1. Siloed and fragmented care delivery systems; 2. Need for a skilled workforce; 3. Attitudes towards addiction (stigma); 4. Limitations in treatment access; and 5. Social and drug related environmental factors. Most experts identified challenges in each major theme; over three-quarters identified issues related to siloed and fragmented systems and the need for a skilled workforce. Each expert mentioned more than one theme, three experts mentioned all five themes and six experts mentioned four themes. CONCLUSIONS: Research, educational, and programmatic agendas should focus on identified topics as a means of improving the lives of patients at risk for or suffering from substance use-related disorders. The results of this project informed funding of pilot interventions designed to address the identified care challenges.

The presidents Drs. Carolyn Britton, MD, MS, of the NMA and Nancy Nielsen, MD, PhD, of the AMA: an interview by George Dawson.

In this edition, we are privileged to have interviewed the current presidents of the National Medical Association (NMA), founded in 1895, and the American Medical Association (AMA), founded in 1847. Drs. Carolyn Britton of the NMA and Nancy Nielsen of the AMA are the 109th and 163rd presidents of their respective organizations. As part of the reconciliation efforts begun by the issuance of a formal apology by the AMA to the nations' African American physicians and the NMA, as they relate to our collective American racial history, we felt it important to include in this process the views of both organizations' presidents. And it just so happens that in this time both presidents happen to be women. The NMA elected its first female president (Edith Erby-Jones, MD) in 1985 and, as of today, they have selected 9 female presidents. The AMA selected its first female president (Nancy Dickey, MD) in 1998, with Dr. Nielsen serving as the second female president ever in AMA history.

Use of antimicrobial agents in consumer products.

OBJECTIVES: To summarize available data on the effectiveness of antimicrobial ingredients in consumer products such as hand lotions and soaps and to discuss the implications of such use on antimicrobial resistance. DATA SOURCES: We searched the MEDLINE database, 1966 to 2001, using the search term resistance qualified with the terms consumer product(s), OR soap, OR lotion, OR triclosan, and LexisNexis and the World Wide Web using the search strategy antimicrobial resistance AND consumer product. DATA EXTRACTION: English-language articles were selected that provided information on the use of antimicrobial ingredients in consumer products and the effect of this use on antimicrobial resistance. DATA SYNTHESIS: Despite the recent substantial increase in the use of antimicrobial ingredients in consumer products, the effects of this practice have not been studied extensively. No data support the efficacy or necessity of antimicrobial agents in such products, and a growing number of studies suggest increasing acquired bacterial resistance to them. Studies also suggest that acquired resistance to the antimicrobial agents used in consumer products may predispose bacteria to resistance against therapeutic antibiotics, but further research is needed. Considering available data and the critical nature of the antibiotic-resistance problem, it is prudent to avoid the use of antimicrobial agents in consumer products. CONCLUSIONS: The use of common antimicrobials for which acquired bacterial resistance has been demonstrated should be discontinued in consumer products unless data emerge to conclusively show that such resistance has no effect on public health and that such products are effective at preventing infection. Ultimately, antibiotic resistance must be controlled through judicious use of antibiotics by health care professionals and the public.