Trends In The Use Of Treatment For Substance Use Disorders, 2010-19.

Rapidly rising drug overdose rates in the United States during the past decade underscore the need to increase access to treatment among people with substance use disorders (SUDs). We analyzed trends in the use of treatment services among people with SUDs during the period 2010-19, using data from the National Survey on Drug Use and Health. Compared with 2013, outpatient visits for general health in the prior year increased 3.6 percentage points by the 2017-19 period. Use of any SUD treatment in the prior year remained unchanged, but treatment use among people involved in the criminal legal system increased by about 6.2 percentage points by the end of the study period. Among those receiving SUD treatment, there was a 14.9-percentage-point increase in having treatment paid for by Medicaid between 2010-13 and 2017-19. Although access to general medical care and insurance coverage have improved for people with SUD, our study findings underscore the importance of renewed efforts to increase the use of SUD treatment.

Association Between the Maryland Medicaid Behavioral Health Home Program and Cancer Screening in People With Serious Mental Illness.

OBJECTIVE: This study evaluated the association of the Maryland Medicaid behavioral health home (BHH) integrated care program with cancer screening. METHODS: Using administrative claims data from October 2012 to September 2016, the authors measured cancer screening among 12,176 adults in Maryland's psychiatric rehabilitation program who were eligible for cervical (N=6,811), breast (N=1,658), and colorectal (N=3,430) cancer screening. Marginal structural modeling was used to examine the association between receipt of annual cancer screening and whether participants had ever enrolled in a BHH (enrolled: N=3,298, 27%; not enrolled: N=8,878, 73%). RESULTS: Relative to nonenrollment, BHH enrollment was associated with increased screening for cervical and breast cancer but not for colorectal cancer. Predicted annual rates remained low, even in BHHs. CONCLUSIONS: Despite estimates of improvements in cervical and breast cancer screening after BHH implementation, cancer screening rates remained suboptimal. Broader cancer screening interventions are needed to improve cancer screening for people with mental illness.

The effects of the Maryland Medicaid Health Home Waiver on Emergency Department and inpatient utilization among individuals with serious mental illness.

OBJECTIVE: The Maryland Medicaid health home program, established through the Affordable Care Act's Medicaid health home waiver, integrates primary care services into specialty mental health programs for adults with serious mental illness (SMI). We evaluated the effect of this program on all-cause, physical, and behavioral health emergency department (ED) and inpatient utilization. METHOD: Using marginal structural modeling to control for time-invariant and time-varying confounding, we analyzed Medicaid administrative claims data for 12,232 enrollees with SMI from October 1, 2012 to December 31, 2016; 3319 individuals were enrolled in a BHH and 8913 were never enrolled. RESULTS: Health home enrollment was associated with reduced probability of all-cause (PP: 0.23 BHH enrollment vs. 0.26 non-enrollment, p < 0.01) and physical health ED visits (PP: 0.21 BHH enrollment vs. 0.24 non-enrollment, p < 0.01) and no effect on inpatient admissions per person-three-month period. CONCLUSION: These results suggest the Maryland Medicaid health home waiver's focus on supporting physical health care coordination by specialty mental health programs may be preventing ED visits among adults with SMI, although effect sizes are small.

Message framing to reduce stigma and increase support for policies to improve the wellbeing of people with prior drug convictions.

BACKGROUND: Individuals with drug convictions are at heightened risk of poor health, due in part to punitive public policies. This study tests the effects of message frames on: (1) public stigma towards individuals with felony drug convictions and (2) support for four policies in the United States (U.S.) affecting social determinants of health: mandatory minimum sentencing laws, 'ban-the-box' employment laws, and restrictions to supplemental nutrition and public housing programs. METHODS: A randomized experiment (n = 3,758) was conducted in April 2018 using a nationally representative online survey panel in the U.S. Participants were randomized to a no-exposure arm or one of nine exposure arms combining: (1) a description of the consequences of incarceration and community reentry framed in one of three ways: a public safety issue, a social justice issue or having an impact on the children of incarcerated individuals, (2) a narrative description of an individual released from prison, and (3) a picture depicting the race of the narrative subject. Logistic regression was used to assess effects of the frames. RESULTS: Social justice and the impact on children framing lowered social distance measures and increased support for ban-the-box laws. CONCLUSION: These findings can inform the development of communication strategies to reduce stigma and advocacy efforts to support the elimination of punitive polices towards individuals with drug convictions.

The emerging public discourse on state legalization of marijuana for recreational use in the US: Analysis of news media coverage, 2010-2014.

OBJECTIVES: US states have begun to legalize marijuana for recreational use. In the absence of clear scientific evidence regarding the likely public health consequences of legalization, it is important to understand how the risks and benefits of this policy are being discussed in the national dialogue. To assess the public discourse on recreational marijuana policy, we assessed the volume and content of US news media coverage of the topic. METHOD: We analyzed the content of a 20% random sample of news stories published/aired in high circulation/viewership print, television, and Internet news sources from 2010 to 2014 (N=610). RESULTS: News media coverage of recreational marijuana policy was heavily concentrated in news outlets from the four states (AK, CO, OR, WA) and DC that legalized marijuana for recreational use during the study period. Overall, 53% of news stories mentioned pro-legalization arguments and 47% mentioned anti-legalization arguments. The most frequent pro-legalization arguments posited that legalization would reduce criminal justice involvement/costs (20% of news stories) and increase tax revenue (19%). Anti-legalization arguments centered on adverse public health consequences, such as detriments to youth health and well-being (22%) and marijuana-impaired driving (6%). Some evidence-informed public health regulatory options, like marketing and packaging restrictions, were mentioned in 5% of news stories or fewer. CONCLUSION: As additional states continue to debate legalization of marijuana for recreational use, it is critical for the public health community to develop communication strategies that accurately convey the rapidly evolving research evidence regarding recreational marijuana policy.

Justice-Involved Adults With Substance Use Disorders: Coverage Increased But Rates Of Treatment Did Not In 2014.

More than one-third of US adults in the criminal justice system have substance use disorders, which contribute to health problems and recidivism. Health insurance and criminal justice reforms initiated in the last decade offer opportunities for increasing treatment access among justice-involved individuals. Using national survey data, we examined trends in treatment of substance use disorders from 2004 to 2014 among adults who reported past-year criminal justice contact and met screening criteria for substance use disorders. We found that the uninsurance rate was relatively unchanged in that population from 2004 to 2013. In 2014, the first year of the Affordable Care Act Medicaid expansion, the uninsurance rate among justice-involved individuals with substance use disorders declined from 38 percent to 28 percent. Although overall treatment rates did not increase in 2014, individuals receiving treatment were more likely to have their care paid for by Medicaid than in the prior decade. Medicaid reimbursement can be a critical lever for improving the quality and continuity of substance use disorder treatment for justice-involved populations.

Improving Health Care Linkages for Persons: The Cook County Jail Medicaid Enrollment Initiative.

The Affordable Care Act has created an unprecedented opportunity to enroll criminal justice-involved individuals in Medicaid. Many jurisdictions within Medicaid expansion states are launching efforts to enroll this population in health insurance and provide connections to services in the community. This study examined one early initiative to enroll individuals in Medicaid during the intake process at the Cook County Jail in Illinois. Several elements were identified as critical to the program's success: key early planning decisions made within the context of a cross-agency group, a high level of dedication among partnering organization leaders, program buy-in among security personnel, and the unique way in which Cook County verifies inmate identity for Medicaid enrollment purposes. These features can potentially guide other jurisdictions attempting to implement similar initiatives.

Leveraging The Affordable Care Act To Enroll Justice-Involved Populations In Medicaid: State And Local Efforts.

The Affordable Care Act provides an unprecedented opportunity to enroll criminal justice-involved populations in health insurance, particularly Medicaid. As a result, many state and county corrections departments have launched programs that incorporate Medicaid enrollment in discharge planning. Our study characterizes the national landscape of programs enrolling criminal justice-involved populations in Medicaid as of January 2015. We provide an overview of sixty-four programs operating in jails, prisons, or community probation and parole systems that enroll individuals during detention, incarceration, and the release process. We describe the variation among the programs in terms of settings, personnel, timing of eligibility screening, and target populations. Seventy-seven percent of the programs are located in jails, and 56 percent use personnel from public health or social service agencies. We describe four practices that have facilitated the Medicaid enrollment process: suspending instead of terminating Medicaid benefits upon incarceration, presuming that an individual is eligible for Medicaid before the process is completed, allowing enrollment during incarceration, and accepting alternative forms of identification for enrollment. The criminal justice system is a complex one that requires a variety of approaches to enroll individuals in Medicaid. Future research should examine how these approaches influence health and criminal justice outcomes.