This Viewpoint examines how artificial intelligence could reshape health care, as new technologies enable the move from traditional health care organizations to direct-to-consumer models.
{"title":"How AI Could Reshape Health Care—Rise in Direct-to-Consumer Models","authors":"Kenneth D. Mandl","doi":"10.1001/jama.2025.0946","DOIUrl":"https://doi.org/10.1001/jama.2025.0946","url":null,"abstract":"This Viewpoint examines how artificial intelligence could reshape health care, as new technologies enable the move from traditional health care organizations to direct-to-consumer models.","PeriodicalId":518009,"journal":{"name":"JAMA","volume":"51 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143477863","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Alexander Lundberg, Lori Post, Jay Unick, Danielle McCarthy, Sarah Welch, Kena Noland, Katie Lawler, Maryann Mason
This study uses 2021 data on the percentage of unavailable opioid tests in the US to examine how opioid involvement informs injury death investigations.
{"title":"Percentage of Opioid Tests Available in US Injury Death Investigations, 2021","authors":"Alexander Lundberg, Lori Post, Jay Unick, Danielle McCarthy, Sarah Welch, Kena Noland, Katie Lawler, Maryann Mason","doi":"10.1001/jama.2024.28709","DOIUrl":"https://doi.org/10.1001/jama.2024.28709","url":null,"abstract":"This study uses 2021 data on the percentage of unavailable opioid tests in the US to examine how opioid involvement informs injury death investigations.","PeriodicalId":518009,"journal":{"name":"JAMA","volume":"16 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143444022","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This JAMA Patient Page describes harm reduction strategies for people who use drugs, which include testing for drug contaminants, overdose prevention, and reducing risk of infectious disease transmission.
{"title":"Harm Reduction Strategies for People Who Use Drugs","authors":"Rebecca Voelker","doi":"10.1001/jama.2025.0178","DOIUrl":"https://doi.org/10.1001/jama.2025.0178","url":null,"abstract":"This JAMA Patient Page describes harm reduction strategies for people who use drugs, which include testing for drug contaminants, overdose prevention, and reducing risk of infectious disease transmission.","PeriodicalId":518009,"journal":{"name":"JAMA","volume":"13 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143444013","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ryan D. Assaf, Meghan D. Morris, Elana R. Straus, Priest Martinez, Morgan M. Philbin, Margot Kushel
ImportanceThe lack of representative research on homelessness risks mischaracterizing and misrepresenting the prevalence of illicit substance use.ObjectiveTo estimate the population prevalence and patterns of illicit substance use, treatment, nonfatal overdose, and naloxone possession among people experiencing homelessness in 1 US state.Design, Setting, and ParticipantsThis representative survey study of adults experiencing homelessness from October 2021 to November 2022 in 8 California counties used multistaged probability-based sampling and respondent-driven sampling. Eligible individuals were 18 years or older and met the federal definition of homelessness.Main Outcomes and MeasuresThe primary outcome measures included lifetime and past–6-month illicit substance use and substance type (methamphetamine, nonprescription opioids, or cocaine). Lifetime and current substance use treatment, unmet treatment need, types of treatments received, nonfatal overdose (lifetime and current episode of homelessness), and current possession of naloxone were measured. Population prevalence estimates with 95% Wald CIs were calculated using survey replicate weights.ResultsOf 3865 individuals approached, 3042 (79%) participated and an additional 158 participants were recruited through respondent-driven sampling. Among 3200 participants, the mean age was 46.1 (95% CI, 45.3-46.9) years, 67.3% (95% CI, 65.2%-69.3%) were cisgender male, and there were similar proportions of Black and African American, Hispanic and Latine, and White participants. Overall, an estimated 65.3% (95% CI, 62.2%-68.4%) of participants used illicit drugs regularly (≥3 times per week) in their lifetime; 41.6% (95% CI, 39.4%-43.8%) began using regularly before their first episode of homelessness and 23.2% (95% CI, 20.5%-25.9%) began using regularly after. In the past 6 months, an estimated 37.1% (95% CI, 32.9%-41.3%) of participants reported regular use of any drug; 33.1% (95% CI, 29.4%-36.7%) reported use of methamphetamines, 10.4% (95% CI, 7.9%-12.9%) reported use of opioids, and 3.2% (95% CI, 1.8%-4.6%) reported use of cocaine. In their lifetime, an estimated 25.6% (95% CI, 22.8%-28.3%) injected drugs and 11.8% (95% CI, 9.8%-13.8%) injected drugs in the past 6 months. Among those with any regular lifetime use, an estimated 6.7% (95% CI, 3.8%-9.5%) of participants were currently receiving treatment. Of those with any regular use in the last 6 months, an estimated 21.2% (95% CI, 17.9%-24.5%) reported currently wanting but not receiving treatment. An estimated 19.6% (95% CI, 17.4%-21.8%) of participants had a nonfatal overdose in their lifetime and 24.9% (95% CI, 21.3%-28.5%) currently possessed naloxone.Conclusion and RelevanceIn a representative study of adults experiencing homelessness in California, there was a high proportion of current drug use, history of overdose, and unmet need for treatment. Improving access to treatment tailored to the needs of people experiencing homelessness could im
{"title":"Illicit Substance Use and Treatment Access Among Adults Experiencing Homelessness","authors":"Ryan D. Assaf, Meghan D. Morris, Elana R. Straus, Priest Martinez, Morgan M. Philbin, Margot Kushel","doi":"10.1001/jama.2024.27922","DOIUrl":"https://doi.org/10.1001/jama.2024.27922","url":null,"abstract":"ImportanceThe lack of representative research on homelessness risks mischaracterizing and misrepresenting the prevalence of illicit substance use.ObjectiveTo estimate the population prevalence and patterns of illicit substance use, treatment, nonfatal overdose, and naloxone possession among people experiencing homelessness in 1 US state.Design, Setting, and ParticipantsThis representative survey study of adults experiencing homelessness from October 2021 to November 2022 in 8 California counties used multistaged probability-based sampling and respondent-driven sampling. Eligible individuals were 18 years or older and met the federal definition of homelessness.Main Outcomes and MeasuresThe primary outcome measures included lifetime and past–6-month illicit substance use and substance type (methamphetamine, nonprescription opioids, or cocaine). Lifetime and current substance use treatment, unmet treatment need, types of treatments received, nonfatal overdose (lifetime and current episode of homelessness), and current possession of naloxone were measured. Population prevalence estimates with 95% Wald CIs were calculated using survey replicate weights.ResultsOf 3865 individuals approached, 3042 (79%) participated and an additional 158 participants were recruited through respondent-driven sampling. Among 3200 participants, the mean age was 46.1 (95% CI, 45.3-46.9) years, 67.3% (95% CI, 65.2%-69.3%) were cisgender male, and there were similar proportions of Black and African American, Hispanic and Latine, and White participants. Overall, an estimated 65.3% (95% CI, 62.2%-68.4%) of participants used illicit drugs regularly (≥3 times per week) in their lifetime; 41.6% (95% CI, 39.4%-43.8%) began using regularly before their first episode of homelessness and 23.2% (95% CI, 20.5%-25.9%) began using regularly after. In the past 6 months, an estimated 37.1% (95% CI, 32.9%-41.3%) of participants reported regular use of any drug; 33.1% (95% CI, 29.4%-36.7%) reported use of methamphetamines, 10.4% (95% CI, 7.9%-12.9%) reported use of opioids, and 3.2% (95% CI, 1.8%-4.6%) reported use of cocaine. In their lifetime, an estimated 25.6% (95% CI, 22.8%-28.3%) injected drugs and 11.8% (95% CI, 9.8%-13.8%) injected drugs in the past 6 months. Among those with any regular lifetime use, an estimated 6.7% (95% CI, 3.8%-9.5%) of participants were currently receiving treatment. Of those with any regular use in the last 6 months, an estimated 21.2% (95% CI, 17.9%-24.5%) reported currently wanting but not receiving treatment. An estimated 19.6% (95% CI, 17.4%-21.8%) of participants had a nonfatal overdose in their lifetime and 24.9% (95% CI, 21.3%-28.5%) currently possessed naloxone.Conclusion and RelevanceIn a representative study of adults experiencing homelessness in California, there was a high proportion of current drug use, history of overdose, and unmet need for treatment. Improving access to treatment tailored to the needs of people experiencing homelessness could im","PeriodicalId":518009,"journal":{"name":"JAMA","volume":"16 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143444015","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Annette M. Dekker, David L. Schriger, Andrew A. Herring, Elizabeth A. Samuels
ImportanceRates of opioid use disorder (OUD) and associated mortality in the US remain high. Treatment of OUD with buprenorphine reduces morbidity and mortality. There have been national efforts to expand buprenorphine initiation to the emergency department (ED), where many patients with low treatment access seek medical care. Adoption and trends of emergency clinician buprenorphine prescribing are unknown.ObjectiveTo describe emergency clinician buprenorphine initiation for OUD, subsequent prescriptions, and changes over time in California.Design, Setting, and ParticipantsObservational retrospective study of buprenorphine prescriptions in the California Controlled Substance Utilization Review and Evaluation System (CURES) database from January 1, 2017, to December 31, 2022. Any patient aged 18 to 79 years with a California zip code who filled a buprenorphine prescription in CURES and their California prescribers were eligible for inclusion.ExposureBuprenorphine prescription by an emergency clinician.Main Outcomes and MeasuresOutcomes included (1) the number of patients prescribed buprenorphine; (2) the number of clinicians prescribing buprenorphine; (3) the number and characteristics of buprenorphine prescriptions; (4) the percentage of emergency clinician buprenorphine initiation prescriptions with subsequent linkage to a second prescription and continuous prescriptions, also reported as a continuation ratio; and (5) days and number of initiation prescriptions prior to continuous prescriptions.ResultsIn this retrospective observational study, 345 024 patients received 3.8 million buprenorphine prescriptions from 21 099 clinicians in California from 2017 to 2022. The mean age of patients at the time of first buprenorphine prescription was 37 years; 8187 (67%) were male. Emergency clinicians increased from 2% (n = 78) to 16% (n = 1789) of buprenorphine prescribers in 2017 and 2022, respectively (P < .001). Buprenorphine initiation prescriptions by emergency clinicians increased from 0.1% (n = 53) to 5% (n = 4493) of all initiation prescriptions in 2017 and 2022, respectively (P = .001). The continuation ratio for patients to receive a second prescription within 40 days of an ED initiation was 2.8 (10 823/3916). The continuation ratio for patients to start 180 days or more of continuous prescriptions within 40 days of ED buprenorphine initiation was 18.3 (10 823/593) and 9.1 within 1 year (5989/655 [2017-2021 data]).Conclusions and RelevanceThese findings suggest increasing prescription of buprenorphine for OUD by California emergency clinicians from 2017 to 2022, with approximately 1 in 9 patients going on to receive continuous buprenorphine prescriptions within 1 year.
{"title":"Emergency Clinician Buprenorphine Initiation, Subsequent Prescriptions, and Continuous Prescriptions","authors":"Annette M. Dekker, David L. Schriger, Andrew A. Herring, Elizabeth A. Samuels","doi":"10.1001/jama.2024.27976","DOIUrl":"https://doi.org/10.1001/jama.2024.27976","url":null,"abstract":"ImportanceRates of opioid use disorder (OUD) and associated mortality in the US remain high. Treatment of OUD with buprenorphine reduces morbidity and mortality. There have been national efforts to expand buprenorphine initiation to the emergency department (ED), where many patients with low treatment access seek medical care. Adoption and trends of emergency clinician buprenorphine prescribing are unknown.ObjectiveTo describe emergency clinician buprenorphine initiation for OUD, subsequent prescriptions, and changes over time in California.Design, Setting, and ParticipantsObservational retrospective study of buprenorphine prescriptions in the California Controlled Substance Utilization Review and Evaluation System (CURES) database from January 1, 2017, to December 31, 2022. Any patient aged 18 to 79 years with a California zip code who filled a buprenorphine prescription in CURES and their California prescribers were eligible for inclusion.ExposureBuprenorphine prescription by an emergency clinician.Main Outcomes and MeasuresOutcomes included (1) the number of patients prescribed buprenorphine; (2) the number of clinicians prescribing buprenorphine; (3) the number and characteristics of buprenorphine prescriptions; (4) the percentage of emergency clinician buprenorphine initiation prescriptions with subsequent linkage to a second prescription and continuous prescriptions, also reported as a continuation ratio; and (5) days and number of initiation prescriptions prior to continuous prescriptions.ResultsIn this retrospective observational study, 345 024 patients received 3.8 million buprenorphine prescriptions from 21 099 clinicians in California from 2017 to 2022. The mean age of patients at the time of first buprenorphine prescription was 37 years; 8187 (67%) were male. Emergency clinicians increased from 2% (n = 78) to 16% (n = 1789) of buprenorphine prescribers in 2017 and 2022, respectively (<jats:italic>P</jats:italic> &amp;lt; .001). Buprenorphine initiation prescriptions by emergency clinicians increased from 0.1% (n = 53) to 5% (n = 4493) of all initiation prescriptions in 2017 and 2022, respectively (<jats:italic>P</jats:italic> = .001). The continuation ratio for patients to receive a second prescription within 40 days of an ED initiation was 2.8 (10 823/3916). The continuation ratio for patients to start 180 days or more of continuous prescriptions within 40 days of ED buprenorphine initiation was 18.3 (10 823/593) and 9.1 within 1 year (5989/655 [2017-2021 data]).Conclusions and RelevanceThese findings suggest increasing prescription of buprenorphine for OUD by California emergency clinicians from 2017 to 2022, with approximately 1 in 9 patients going on to receive continuous buprenorphine prescriptions within 1 year.","PeriodicalId":518009,"journal":{"name":"JAMA","volume":"25 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143444014","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Roy H. Hamilton, Zachary J. Williams, Edward S. Brodkin
This Viewpoint discusses advancing physician workforce diversity via neurodiversity, the range of developmental neurocognitive differences that underlie individual variation in thinking, learning, and behavior.
{"title":"Embracing Neurodiversity in Medicine—Building a More Inclusive Physician Workforce","authors":"Roy H. Hamilton, Zachary J. Williams, Edward S. Brodkin","doi":"10.1001/jama.2025.0094","DOIUrl":"https://doi.org/10.1001/jama.2025.0094","url":null,"abstract":"This Viewpoint discusses advancing physician workforce diversity via neurodiversity, the range of developmental neurocognitive differences that underlie individual variation in thinking, learning, and behavior.","PeriodicalId":518009,"journal":{"name":"JAMA","volume":"14 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143444016","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This Guide to Statistics and Methods provides an overview of platform trials, describes the characteristics that make them more efficient for evidence generation, and discusses their limitations.
{"title":"Platform Clinical Trials for the Efficient Evaluation of Multiple Treatments","authors":"Steve A. Webb, Lennie P. G. Derde","doi":"10.1001/jama.2024.27688","DOIUrl":"https://doi.org/10.1001/jama.2024.27688","url":null,"abstract":"This Guide to Statistics and Methods provides an overview of platform trials, describes the characteristics that make them more efficient for evidence generation, and discusses their limitations.","PeriodicalId":518009,"journal":{"name":"JAMA","volume":"12 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143427391","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Matthew B. Lawrence, Allison Hickman, Allison LoPilato, Justine W. Welsh
This Viewpoint discusses the need for researchers and clinicians to consider questions of legal relevance in designing their studies and communicating their findings to help in developing policies regarding social media to improve children’s well-being.
{"title":"What Courts Are Asking Medicine About Social Media","authors":"Matthew B. Lawrence, Allison Hickman, Allison LoPilato, Justine W. Welsh","doi":"10.1001/jama.2025.0472","DOIUrl":"https://doi.org/10.1001/jama.2025.0472","url":null,"abstract":"This Viewpoint discusses the need for researchers and clinicians to consider questions of legal relevance in designing their studies and communicating their findings to help in developing policies regarding social media to improve children’s well-being.","PeriodicalId":518009,"journal":{"name":"JAMA","volume":"29 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143427389","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ozan Unlu, Matthew Varugheese, Jiyeon Shin, Samantha M. Subramaniam, David Walter Jacques Stein, John J. St Laurent, Charlotte J. Mailly, Marian J. McPartlin, Fei Wang, Michael F. Oates, Christopher P. Cannon, Benjamin M. Scirica, Kavishwar B. Wagholikar, Samuel J. Aronson, Alexander J. Blood
This randomized clinical trial compares the efficiency of prescreening patients with heart failure using an artificial intelligence (AI) large language model for inclusion in a clinical trial vs manual prescreening.
{"title":"Manual vs AI-Assisted Prescreening for Trial Eligibility Using Large Language Models—A Randomized Clinical Trial","authors":"Ozan Unlu, Matthew Varugheese, Jiyeon Shin, Samantha M. Subramaniam, David Walter Jacques Stein, John J. St Laurent, Charlotte J. Mailly, Marian J. McPartlin, Fei Wang, Michael F. Oates, Christopher P. Cannon, Benjamin M. Scirica, Kavishwar B. Wagholikar, Samuel J. Aronson, Alexander J. Blood","doi":"10.1001/jama.2024.28047","DOIUrl":"https://doi.org/10.1001/jama.2024.28047","url":null,"abstract":"This randomized clinical trial compares the efficiency of prescreening patients with heart failure using an artificial intelligence (AI) large language model for inclusion in a clinical trial vs manual prescreening.","PeriodicalId":518009,"journal":{"name":"JAMA","volume":"2 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143427390","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This Viewpoint considers unjust enrichment stemming from the use of biospecimens known as offering particular value without informing the patient or gaining consent, as in the case of Henrietta Lacks.
{"title":"The Second Legacy of Henrietta Lacks","authors":"Jerry Menikoff","doi":"10.1001/jama.2025.1074","DOIUrl":"https://doi.org/10.1001/jama.2025.1074","url":null,"abstract":"This Viewpoint considers unjust enrichment stemming from the use of biospecimens known as offering particular value without informing the patient or gaining consent, as in the case of Henrietta Lacks.","PeriodicalId":518009,"journal":{"name":"JAMA","volume":"23 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143427407","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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