May 2019: The Substance Abuse Issue
This May/June issue of the Journal of Public Health Management and Practice focuses on substance abuse and related disorders. Leading off is a commentary by Beitsch and Langhinrichsen-Rohling “Avoiding Déjà vu All Over Again: Inserting Public Health/Mental/Behavioral Health, and Prevention Policy Into the Opiate Crisis Litigation.” Linking the current substance abuse problem to tobacco, they refer to the notable successes that public health accomplished with respect to nicotine dependency. They reflect their disappointment that the Tobacco Master Settlement Agreement of $250 billion did not result in a large investment of these dollars in tobacco control, but rather was used for roads, bridges, and taxpayer rebates. However, they recount the large number of opioid lawsuits now being filed against pharmaceutical defendants including, as of August 18, 2018, 27 states suing Purdue Pharma, the maker of OxyContin. They assert that an innovative class action settlement can provide funding to address the entirety of the opioid crisis. They direct us to lessons from the Gulf Region Health Outreach Program (GRHOP) where a settlement following the oil spill disaster from Deepwater Horizon included a set-aside of $105 million for a coordinated public health and behavioral health initiative. This effort was described in a 2017 supplemental issue of this journal. The authors of this commentary were among the group of guest editors.
Hedberg and co-authors describe the opioid epidemic in Oregon and an initiative launched in 2015 which decreases opioid prescribing including statewide guidelines and coverage standards for opioid and non-opioids for back pain in the Medicaid program. Their approach spans public health and health care systems, involves key stakeholders, and uses data to identify strategies to decrease misuse and overdose.
South Carolina is one of the states in the southern region that experiences an unusually high rate of opioid related deaths. In 2016, 616 deaths from this cause occurred in South Carolina. In 2015, residents of this state filled nearly 4.5 million opioid prescriptions, which is greater than 1.5 times the national average. In 2017, Governor Henry McMaster declared a statewide public health emergency in response to this crisis. In January of 2018, a committee of the South Carolina House of Representatives released a report in response with recommendations to reduce the number of opioid deaths. In this journal issue, Arnold and colleagues examine the strengths and weaknesses of South Carolina’s action plan in comparison to what other states have done to address opioid abuse.
McNeely and colleagues describe a pioneering program in their article “Expanding Contraceptive Access for Women with Substance Abuse Disorders: Partnerships Between Public Health Departments and County Jails.” Many women inmates in county jails suffer with substance abuse problems. The East Region of the Tennessee Department of Health partnered with county correctional facilities to provide comprehensive family planning education and voluntary long-acting reversible contraception. The lack of contraceptive access for women with substance abuse problems not only limits their ability to effectively plan their families but has substantial medical and public health consequences. The repeated prenatal use of opioids can cause low birth weight and neonatal abstinence syndrome.
Several of the articles in this issue describe conditions related to substance abuse, including hepatitis C and sexually-transmitted disease. Salway and co-authors describe the need and desire for mental health and substance abuse services among clients of publicly funded sexually transmitted infection clinics in Vancouver, Canada. Among 1,115 patients, nearly 40% reported a need for MHSU (mental health/substance abuse) care most frequently in relation to anxiety, depression, substance abuse, or suicide ideation.
Michael Fraser, Executive Director of ASTHO, a proponent of the case study format for training of state health officials and others, has requested the development of articles illustrating leadership in challenging environments. The first of these cases illustrating the efforts of the Florida Department of Health, combatting locally transmitted Zika in Miami-Dade County, appears in this issue. Following the report on July 7, 2016, of the first non-travel related Zika case in the United States in a 23 year-old pregnant woman, Secretary of Health Celeste Philip mobilized her agency to perform unique surveillance, mosquito abatement, and media relation strategies. Issues related to tourism and reproductive health needed careful management.
Lloyd F. Novick, MD, MPH is Professor Emeritus of the Department of Public Health at the Brody School of Medicine, East Carolina University. Previously, he was chair of this Department. He has served as the Commissioner of Health and Secretary for Human Services of Vermont, Director of Health Services for Arizona, and Director of the Office of Public Health for New York State. Previous academic positions include Professor and Director of the Preventive Medicine Program for SUNY Upstate Medical University, Professor and Chair of Epidemiology at the University of Albany School of Public Health, and Clinical Professor and Director of the Teaching Program in Epidemiology and Public Health at the University of Vermont, College of Medicine. [Full bio]
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