Milbank Quarterly最新文献

Policy Points Improving care for people with mental health (MH) and substance use disorder (SUD) conditions is a top priority for Medicaid leaders. Medicaid has often led the way for Medicare and other payers in coverage of MH and SUD services and in modeling the applied practice of cross-disciplinary work, but there is more work to be done to develop a comprehensive, community-based system of care for MH and SUD conditions. Medicaid's work in MH and SUD conditions is both standard bearing and an important work in progress.

Policy Points After the repeal of National Prohibition in 1933, the federal government gave states the bulk of the regulatory power over alcohol. Although states used this power early on, particularly since the 1970s state action on alcohol has largely liberalized alcohol control structures, allowed taxes' real value to decline with inflation, expanded physical availability, and failed to limit alcohol marketing. With declining federal funds for public health and health care, states have the power today to use alcohol taxes to raise much-needed revenues, and reduce alcohol problems while funding a range of needed programs and services.

Policy Points Laws on drug use during pregnancy are enforced more harshly against structurally marginalized people. Despite this pattern, these laws' impacts on health and health care inequities are understudied. We offer recommendations for novel, robust research to generate evidence on this essential topic.

Policy Points The government has a key role in ensuring equitable and just health care access for all constituents, including those involved with the criminal legal system. Multi-agency collaboration is a critical and effective path to ensure equitable health care access. Incarceration events can cause delays and disruptions in substance use disorder treatment, and treatment in carceral settings can prevent these adverse outcomes. Multi-agency collaborations can be strengthened by legislation, leadership support, the identification of shared goals, methods to share data, and subsequent accountability.

Policy Points There have been significant advancements in expanding care for opioid use disorder and suicide in general medical settings in the first quarter of the 21st century. Incessant barriers in the US health system continue to hinder progress in sufficiently scaling up evidence-based behavioral health interventions and getting them to those at highest risk. State policymakers have multiple levers available to make significant improvements to address ongoing challenges and improve access to evidence-based behavioral health services in emergency and primary care settings.

Policy Points There has been a pronounced shift from injecting to smoking drugs in the United States. This shift has the potential to reduce many health harms associated with illicit drug use. State laws are structural barriers to the provision of safer smoking supplies, cause preventable harm, and should be repealed.

Policy Points Among patients with chronic noncancer pain, state medical cannabis laws did not impact health care use for opioid use disorder. There were no changes in health care use for opioid overdose attributable to medical cannabis laws. Medical cannabis laws do not appear to lead to reductions in adverse opioid-related outcomes.

Context: State medical cannabis laws, currently in place in 39 states and Washington, DC, provide an avenue for therapeutic use of cannabis to manage chronic noncancer pain stemming from conditions such as arthritis and low back pain. These laws may also influence cannabis and opioid addiction and overdose, for example, if people substitute cannabis in place of opioids to manage pain. No studies, to our knowledge, have examined how state medical cannabis laws influence health care use related to addiction to or overdose from cannabis or opioids among people with chronic noncancer pain.

Methods: We used a difference-in-differences design and augmented synthetic control analyses comparing changes in cannabis use disorder (CUD) and opioid use disorder (OUD) treatment and cannabis and opioid overdose-related health care use before and after medical cannabis law implementation among Medicare beneficiaries with chronic noncancer pain in seven states (Florida, Maryland, Minnesota, New Hampshire, New York, Oklahoma, and Pennsylvania) relative to changes in outcomes over the same period in 17 comparison states (Alabama, Georgia, Idaho, Indiana, Iowa, Kansas, Kentucky, Mississippi, Nebraska, North Carolina, South Carolina, South Dakota, Tennessee, Texas, Virginia, Wisconsin, and Wyoming) without medical cannabis laws.

Findings: State medical cannabis laws had an estimated average effect of less than 0.005 percentage points on the overall proportion of patients receiving any CUD or OUD treatment, less than 0.009 percentage points on the proportion of patients newly initiating CUD or OUD treatment, and less than 0.0005 percentage points on the proportion of patients receiving overdose-related health care for cannabis or opioid overdoses (p > 0.05 for all findings).

Conclusions: Our study did not identify effects of state medical cannabis laws on health care use related to CUD or OUD treatment or overdose among Medicare beneficiaries younger than age 65 years with chronic noncancer pain.

Policy Points State policymakers have moved rapidly to regulate adolescent social media use, frequently stating concerns about mental health, harmful content exposure, and developmental impacts. The degree to which policymakers' arguments in favor of state social media regulations correspond to the state of the current scientific evidence remains questionable. The evidence to substantiate policymakers' assertions has substantial limitations in the ability to answer causal questions, but some promising directions are emerging around targeted protections for highly susceptible youth.

Context: The potential adverse effects of social media use for adolescents have received substantial attention. In response, a growing number of state-level social media regulations are emerging in the United States. These policy interventions are being implemented in the context of mixed scientific evidence, forcing policymakers to weigh the need for proactive regulation against the limitations of extant research. We explore policymakers' publicly stated rationales for social media regulations and contextualize their claims within extant scientific literature.

Methods: We conducted a media content analysis of elected government officials' statements about 69 state social media legislative initiatives that were adopted or enacted prior to September 2024 using Google News. Subsequently, we critically reviewed the strength of the evidence underlying common themes.

Findings: We screened 637 documents, included 161, and extracted three main themes connected to claims about social media-related adolescent harms: (1) harm to adolescents' mental health (mentioned in 55 articles), including six subthemes (e.g., social media addiction, self-harm or suicide, anxiety and depression); (2) exposure to dangerous online content (73 mentions), including five subthemes (e.g., access to pornography, risks of sexual exploitation); and (3) harm to adolescent development (38 mentions), including three subthemes (i.e., negative impacts on learning, social relationships, and brain development). We identified some evidence to support associations between social media use and adverse outcomes, particularly for vulnerable youth, but, overall, the current research base has significant limitations and cannot definitively establish causal effects.

Conclusions: State policymakers have moved rapidly to regulate adolescent social media use, often citing concerns about mental health, harmful content, and developmental impacts. The evidence to substantiate these assertions remains preliminary, but some promising directions are emerging around targeted protections for highly susceptible youth. We formulate a research agenda to inform evidence-based policy.