Richard G. Frank and Carrie E. Fry. 4/14/2019. “
The Impact of Medicaid Expansion on Access to Naloxone.” Addiction 114, Pp. 1567-74.
Full paperAbstractBackground and Aims: Deaths from opioid-related overdoses continue to grow, in part due to the increasing lethality of substances being consumed (e.g., fentanyl). Federal, state, and local governments have sought public policy interventions to reduce the number of deaths due to opioids, including increasing the availability of naloxone. The Affordable Care Act (ACA) expanded Medicaid coverage to low-income, childless adults, potentially giving this group financial access to naloxone.
Methods: We use data from the Medicaid Drug Rebate Program to estimate the impact of Medicaid expansion and Medicaid-covered naloxone. We use difference-in-differences regression analysis to compare states that did not expand to states that did expand before and after Medicaid expansion.
Results: Prior to Medicaid expansion, the number of Medicaid-covered naloxone prescriptions was very similar in expansion and non-expansion states. We find that, on average, states that expanded Medicaid have 78.2 (95%CI: 16.0-140.3;p=0.02) more prescriptions per year for naloxone compared to states that did not expand after expansion, a nearly 10-fold increase over the pre-expansion years. We also find Medicaid expansion contributed to this growth in Medicaid-covered naloxone more than other state-level naloxone policies.
Conclusions: Medicaid expansion has likely put naloxone into the hands of some of the people best positioned to prevent death from an overdose – individuals without opioid use disorder and their friends and members. The difference in difference results imply that the Medicaid expansion accounted for about 8.3% of the growth in take-home naloxone units from 2009 to 2016 holding other factors constant. Additionally, Medicaid is responsible for approximately 13% of the growth in naloxone prescriptions between 2009-2016. However, Medicaid expansion is not a silver bullet for expanding the use of naloxone and curbing the opioid epidemic. Policy makers must consider other ways to improve prevention, harm reduction, and treatment for opioid use disorder.
Carrie E. Fry, Hilary A. Tindle, Caroline Young, Erin I. Rogus, William H. Frist, and Melinda B. Buntin. 2019. “
Development of a tobacco control “prescription” in a Southern U.S. city.” Progress in Community Health Partnerships, 13, 3, Pp. 237-246.
AbstractThe Problem: Nationwide efforts to reduce smoking in the United States over the past decade have been successful. Yet, there is unequal geographic progress in reducing rates of smoking and smoking-related illnesses. Located in a tobacco-producing state with weak tobacco laws, Nashville has an adult smoking rate of 20.9%, requiring 45,000 smokers to quit to meet the Healthy People 2020 goal of 12%.
Purpose of the Article: The purpose of this article is to detail the process involved in building a community-academic partnership (CAP), gathering national and grassroots support, and devising an implementation strategy for tobacco control.
Key Points: Nashville’s collective impact approach helped prioritize short- and long-term strategies, identified potential barriers to success, created an energetic CAP, provided early “wins”, and inspired research and implementation collaborations.
Conclusion: Other communities interested in improving tobacco control could engage in a similar process to create, implement, and evaluate tailored recommendations to improve the health of its citizens.
Fry et al PCHP Beyond the Manuscript.pdf
Fry, et al 2019 PCHP.pdf