Substance Use

The use or misuse of substances such as alcohol, tobacco, cannabis (marijuana), stimulants, hallucinogens, and opioids.

Medicaid Expansion Increased Use of Medications for Opioid Use Among Individuals with Criminal Justice Involvement

Apr. 5, 2021

Individuals involved in the criminal justice system have high rates of opioid use disorder (OUD), but frequently have limited options for treatment. The Affordable Care Act’s Medicaid expansion gave states the opportunity to increase coverage for individuals with criminal justice involvement, but whether that translated into increased access to OUD treatment in this population is an open question.

The Fierce Urgency of the Overdose Crisis

Mar. 30, 2021

In the past few months, we have seen what can be accomplished when the federal government marshalls its resources and mobilizes a nation to address a health crisis. While there is no vaccine for the epidemic of overdoses that has claimed more than 80,000 lives in the past year alone, we already have effective treatments for opioid use disorders and proven life-saving strategies. There is an urgent need for federal leadership to address an overdose crisis that has worsened throughout the pandemic.

Ending the Opioid and Overdose Crisis

Mar. 30, 2021

The pandemic has worsened an existing drug overdose crisis that claimed the lives of more than 81,000 people in the U.S. from May 2019-June 2020. As the Biden-Harris administration firms up and implements its proposed response to the opioid epidemic, this brief provides evidence-based recommendations to consider.


We focus our recommendations on the evidence and our experience in three areas: reducing the demand for opioids through policies that increase access to prevention, treatment, and recovery services; reducing the harms from opioid use through strategies that reduce morbidity and mortality; and reducing the supply of opioids through opioid stewardship that limits prescribing by the medical community and promotes adequate pain management. We also address the accountability of the pharmaceutical industry in contributing to the crisis and recommend ways to target settlement funds for maximal impact on the communities most affected.

Opioid Use in Pregnant Women With Mental Health-Related Disabilities

Jan. 10, 2021

Panagiota Kitsantas, Amy R. Adams, Jehanzeb Cheema, Melanie L. Kornides 

Abstract [from journal]

Purpose: The purpose of this study was to examine associations between opioid use and the degree of mental health-related disability due to emotional/behavioral problems as measured by the World Health Organization Disability Assessment Schedule (WHODAS) instrument in a national sample of pregnant women.

Methods: We used data from the National Survey on Drug Use and Health 2014-2017 which included 2,888 pregnant women 18 years or older. The WHODAS instrument was utilized to measure disability

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Considering the Harms of Our Habits: The Reflexive Urine Drug Screen in Opioid Use Disorder Treatment

Dec. 19, 2020

Utsha G. Khatri, Shoshana V. Aronowitz

Abstract [from journal]

The COVID-19 pandemic has led to abrupt changes in the delivery of substance use treatment, notably the adoption of telehealth services and a departure from mandatory urine drug screens (UDS). Amid current circumstances, the UDS, which had evolved to signal a "successful" recovery, no longer seems feasible, safe, or necessary. Even prior to the pandemic, the UDS had notable drawbacks, including sending a message of mistrust and hierarchy, potentially causing psychological trauma, and incentivizing falsification. Nonetheless, certain

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Health Economic Design for Cost, Cost-Effectiveness and Simulation Analyses in the HEALing Communities Study

Dec. 1, 2020

Arnie P. Aldridge, Carolina Barbosa, Joshua A. Barocas, Joshua L. Bush, Jagpreet Chhatwal, Kristin J. Harlow, Ayaz Hyder, Benjamin P. Linas, Kathryn E. McCollister, Jake R. Morgan, Sean M. Murphy, Caroline Savitzky, Bruce R. Schackman, Eric E. Seiber, Laura E. Starbird, Jennifer...

Abstract [from journal]

Background: The HEALing Communities Study (HCS) is designed to implement and evaluate the Communities That HEAL (CTH) intervention, a conceptually driven framework to assist communities in selecting and adopting evidence-based practices to reduce opioid overdose deaths. The goal of the HCS is to produce generalizable information for policy makers and community stakeholders seeking to implement CTH or a similar community intervention. To support this objective, one aim of the HCS is a health economics study (HES), the

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