Plus: Contingency management stems cocaine use, and an argument for making harm reduction a federal policy
By William Wagner
Ohio State University researchers have found that swaths of Franklin County, Ohio, lack adequate access to opioid treatment. It seems the study can be applied to other parts of the United States.
We also spotlight a study indicating that contingency management is the best way to address cocaine use, as well as the sensible idea of making harm reduction a federal policy.
Some of the treatment deserts that we’re identifying are … in places where racism and discrimination are at play in terms of the resources available. That’s another significant obstacle to access.”—Ayaz Hyder, Ohio State University
From PLOS ONE:
Opioid Treatment “Deserts”
We’ve heard a lot about food “deserts,” impoverished areas where access to groceries is minimal. It seems the same concept applies to opioid treatment. A team from Ohio State University studied data from 2013 to 2017 from emergency management agencies in Franklin County, Ohio, where the state capital, Columbus, is located, to pinpoint gaps in opioid treatment providers. (The researchers designated an area a treatment desert if people had to travel at least a mile or more than 30 minutes via public transportation to reach a provider.) The study, which was published on May 12 in PLOS One, concludes that “[d]isparities in access to opioid treatment exist at the sub-county level in specific neighborhoods and across racial groups in Columbus, Ohio.”
The empty treatment pockets reflect larger societal issues. Upon the publication of the study, Ayaz Hyder, Ph.D., the leader of the research team and an assistant professor at Ohio State’s College of Public Health, said, “Some of the treatment deserts that we’re identifying are … in places where racism and discrimination are at play in terms of the resources available. That’s another significant obstacle to access.” The ultimate goal of the research is to provide policymakers with maps indicating where treatment centers need to be opened in Ohio and beyond.
From the JAMA Network:
Contingency Management Works Best for Cocaine Use
Cocaine, viewed by some as a relic of the high-rolling 1970s and ’80s, is back with a vengeance. Late last year, the Centers for Disease Control and Prevention (CDC) reported that the rate of overdose deaths involving cocaine nearly tripled between 2013 and 2018, after remaining stable from 2009 to 2013.
According to a new study spearheaded by academics from Stanford University, contingency management could provide a much-needed antidote. Analyzing 157 clinical trials (totaling nearly 16,000 participants) related to cocaine published between 1995 and 2017, researchers found that the contingency management treatment model had been more effective than other approaches.
“Although several treatment categories were associated with benefits in the nonimputed data set, when data were imputed to include the complete data set, only contingency management programs were consistently associated with a significant reduction in urinalysis-confirmed cocaine use,” the study’s authors write. “Other treatment categories were not significantly associated with this outcome.”
From The New England Journal of Medicine:
A Federal Policy for Harm Reduction?
The alarming rise in alcohol and substance use during the COVID-19 pandemic has prompted some experts to rethink addiction treatment in general. In a newly published commentary in The New England Journal of Medicine, Kimberly L. Sue, M.D., Ph.D., and David A. Fiellin, M.D., from the Yale Program in Addiction Medicine argue that harm reduction should be on the table as a federal policy. Such a step would, they write, codify the transition already underway from the draconian War on Drugs to a more realistic—and effective—approach to addiction care.
“The focus of federal substance-use policy has shifted from prohibition to criminalization and, increasingly, to regulation,” Sue and Fiellin write. “Cutting-edge 20th-century harm-reduction interventions, such as syringe-services programs (which provide access to sterile syringes for people who inject drugs) and naloxone distribution, which were once banned or discouraged, are now recognized as mainstream medical and public health strategies.”
Top photo: Universal; bottom photo: Ty Lee