Search results

A growing body of research finds a consistently negative relationship between medical cannabis access and aggregate measures of opioid use. Nothing is currently known about the types of opioids that are being most impacted by cannabis access. Using the Callaway and Sant’Anna (2021) difference-in-differences (DID) estimator for the main analysis and data on all opioid shipments to every United States (US) pharmacy from 2006 to 2014, the authors found no evidence of overall change in the total number of morphine milligram equivalent (MME) units of opioids shipped to pharmacies, following the opening of medical cannabis dispensaries. However, across all opioids, the authors found a reduction in the highest MME dosage strengths (8.8% decrease in 50–89 MME doses and 11.3% decrease in 90+ MME doses). This decrease appears to be driven predominantly by commonly diverted opioids, where the authors found a reduction in the highest MME dosage strengths (12.2% in 50–89 MME doses and 13.8% in 90+ MME doses). Further, the authors see a 6.0% increase in low-to-moderate dose opioids (0–49 MMEs). This is consistent with patients using cannabis concomitantly with opioids in order to achieve a lower opioids dose.

The purpose of this paper is to examine lived experiences of opioid agonist treatment (OAT) during and immediately following release from detention in prisons in England and Scotland.

Surveys were completed by serving prisoners in both countries and by those recently released from prison (England only). The survey findings were discussed in focus groups of people with lived experience. The combined findings from the surveys and focus groups were shared with an expert group of prison OAT providers and people with lived experience with the purpose of making recommendations for more accessible and effective OAT in custodial environments and continuity of OAT on release

The quality and accessibility of OAT varied considerably between establishments. It was reported to be harder to access OAT in Scottish prisons. It was often hard for people in prison to get the dosage of OAT they felt they needed and it was generally harder to access buprenorphine than methadone in English prisons. Only Scottish people in prison were aware of long-lasting forms of buprenorphine. People in English prisons had mixed experiences of the help available in prison, with no improvement recorded since a 2016 study. People in Scottish prisons were more likely to rate the help available as poor.

The number of people accessed while actually in prison (73) was reduced by the impact of the pandemic, making it more difficult to access people in prison and because some were resistant to participating on the basis that they had already been consulted for a wide variety of research projects focused on the impact of COVID. The Scottish cohort (a total of 19 individuals comprising 14 survey respondents and five focus group members) is clearly too small a number on which to base robust claims about differences in OAT provision between the English and Scottish prison systems..

The study identifies key barriers to accessing OAT in prisons and suggests key components of more user-friendly approaches.

This study provides an overview of the recent lived experiences of people accessing OAT in prison and on release and offers valuable recommendations on how to make service provision more effective and consistent.

This study provides an overview of the recent lived experiences of people accessing OAT in prison and on release in England and Scotland and offers valuable recommendations on how to make service provision more effective and consistent.

Homelessness has many causes and also is stigmatized in the United States, leading to much misunderstanding of its causes and what policy solutions may ameliorate the problem. The problem is of course getting worse and impacting many communities far removed from the West Coast cities the authors examine in this study. This analysis examines the socioeconomic variables influencing homelessness on the West Coast in recent years. The authors utilize a panel fixed effects model that explicitly includes measures of healthcare access and availability to account for the additional health risks faced by individuals who lack shelter. The authors estimate a spatial error model (SEM) in order to better understand the impacts that systemic shocks, such as the COVID-19 pandemic, have on a variety of factors that directly influence productivity and other measures of welfare such as income inequality, housing supply, healthcare investment, and homelessness.

To address safety risks, worker well-being concerns and productivity losses in construction due to substance misuse, this study aims to explore awareness and usage levels of various substances among Nigerian construction professionals. The findings aim to inform targeted interventions and policy development to tackle these industry-specific challenges.

A comprehensive literature review identified several substances and intoxicants commonly used in construction, which informed the development of a well-structured questionnaire. This questionnaire was distributed to both construction professionals and nonprofessionals. The Shapiro-Wilk test assessed the normality of awareness and utilization scores for each substance, while the Kruskal-Wallis H-test explored significant differences in awareness and usage scores among different respondent groups.

Despite reporting low awareness of substances commonly used in construction, a significant proportion (over 60%) of respondents admitted to using several of these substances in their construction activities. This highlights a concerning disconnect, with more than half (62.5%) exceeding a predefined threshold (3.5) for significant substance use. Ten out of the 16 substances surveyed fell into this category, indicating a widespread issue within the industry.

The findings of this study highlight the need for increased education and awareness programs about the dangers of substance misuse in the construction industry. Construction companies should implement regular training sessions and workshops to educate workers on the risks associated with substance use. Additionally, there should be stricter enforcement of substance use policies and routine substance testing to deter misuse. These measures can enhance safety, improve worker well-being and boost overall productivity in the construction industry.

The insights from this study can inform the development of international policies and best practices for substance use prevention and worker well-being in the construction industry. Sharing these findings with international organizations, policymakers and industry stakeholders can help create broader guidelines and frameworks adaptable for implementation in various countries.

The case is designed to be used with the digital business model framework developed by Peter Weill and Stephanie Woerner of Massachusetts Institute of Technology (MIT) (Weill and Woerner, 2015) and is referred to as the W & W framework. This approach provides a useful structure for thinking through the strategic options facing environments ripe for digital transformation.

Research for this case was conducted through face-to-face interviews with the protagonist, as well as through a review of their business planning documents and other data and documentation provided by the founder. Some of the market and industry data were obtained using secondary research and industry reports. Interviews were digitally recorded and transcribed to ensure accuracy.

The case follows the story of Kurt Waltenbaugh, a Minnesota entrepreneur who shared the dream of using data analytics to reduce costs within the US health-care system. In early 2014, Waltenbaugh and a physician colleague founded Carrot Health to bring together their personal experience and expertise in both consumer data analytics and health care. From the beginning, they focused on how to use data analytics to help identify high-risk/high-cost patients who had not yet sought medical treatment. They believed that they could use these insights to encourage early medical interventions and, as a result, lower the long-term cost of care.

Carrot’s initial success found them in a consultative role, working on behalf of insurance companies. Through this work, they honed their capabilities by helping their clients combine existing claims data with external consumer behavioral data to identify new potential customers. These initial consulting contracts gave Carrot the opportunity to develop its analytic tools, business model and, importantly, to earn some much-needed cash flow during the start-up phase. However, they also learned that, while insurance companies were willing to purchase data insights for one-off market expansion projects, it was much more difficult to motivate them to use data proactively to eliminate costs on an ongoing basis. Waltenbaugh believed that Carrot’s greatest potential lay in their ability to develop predictive models of health outcomes, and this case explores Carrot’s journey through strategic decisions and company transformation.

This case is intended for either an undergraduate or graduate course on entrepreneurial strategy. It provides an effective introduction to the unique structure and constraints which apply to an innovative start-up within the health-care industry. The case also serves as a platform to explore the critical criteria to be considered when developing a digital transformation strategy and exposing students to the digital business model developed by Weill and Woerner (2015) at MIT (referred to in this instructor’s manual as the W&W framework). The case was written to be used in an advanced strategy Master of Business Administration (MBA) class, an undergraduate specialty health-care course or as part of a health-care concentration in a regular MBA, Master of Health Care Administration (MHA) or Master of Public Health (MPH). It may be taught toward the end of a course on business strategy when students are building on generic strategy frameworks and adapting their strategic thinking to the characteristics of specific industries or sectors. However, the case can also be taught as part of a course on health-care innovation in which case it also serves well as an introduction to the health-care payments and insurance system in the USA. Finally, the case can be used in a specialized course on digital transformation strategy in which case it serves as an introduction to the MIT W&W framework.

The case is particularly well-suited to students who are familiar with traditional frameworks for business strategy and business models. The analysis builds on this knowledge and introduces students interested in learning about the opportunities and challenges of digital strategy. Equally, the case works well for students with clinical backgrounds, who are interested in how business strategy can influence changes within the health-care sphere. Finally, an important aspect of the case design was to develop students’ analytical confidence by encouraging them to “get their hands dirty” and to carry out some basic exploratory data analytics themselves. As such, the case requires students to combine and correlate data and to experience the potentially powerful combination of clinical and consumer data. Instructors should find that the insights from these activities give students unique insights into the potential for of data analytics to move health care from a reactive/treatment ethos to a proactive/intervention ethos. This experience can be particularly revealing for students with clinical backgrounds who may initially be resistant to the use of clinical data by commercial organizations.

This study explores the determinants of police officer support for pre-arrest/booking deflection programs that divert people presenting with substance use and/or mental health disorder symptoms out of the criminal justice system and connect them to supportive services.

This study analyzes responses from 254 surveys fielded to police officers in Delaware. Questionnaires asked about views on leadership, approaches toward crime, training, occupational experience and officer’s personal characteristics. The study applies a new machine learning method called kernel-based regularized least squares (KRLS) for non-linearities and interactions among independent variables. Estimates from a KRLS model are compared with those from an ordinary least square regression (OLS) model.

Support for diversion is positively associated with leadership endorsing diversion and thinking of new ways to solve problems. Tough-on-crime attitudes diminish programmatic support. Tenure becomes less predictive of police attitudes in the KRLS model, suggesting interactions with other factors. The KRLS model explains a larger proportion of the variance in officer attitudes than the traditional OLS model.

The study demonstrates the usefulness of the KRLS method for practitioners and scholars seeking to illuminate patterns in police attitudes. It further underscores the importance of agency leadership in legitimizing deflection as a pathway to addressing behavioral health challenges in communities.

New psychoactive substance (NPS) use in mental health and addiction health-care services is a common co-morbidity. This paper aims to explore the survey responses with health-care professional’s (HCPs) engagements and experiences towards people who use NPS in five health-care services.

A theoretically adapted online survey design explored the engagements and experiences of participants towards people who use NPS across (n = 3) community and (n = 2) rehabilitation mental health and addiction health-care services consisting of (n = 1,027) service users.

A total of 92 participants (of 120 participants) completed the survey and 28 did not. Most (56.33%) reported neutral to poor experiences and engagements and a lack of NPS-related policies, procedures and educational training. Participants (99%) recognised the harmful effects of NPSs and (87%) requested clinical assessment procedures. The participants are unable to identify and manage acute intoxication by NPS, lack knowledge of NPS adverse effects and requested NPS-specific training on drug legislation.

The sample may not be representative with the broader UK population. The study’s methods are comparable to similar research surrounding NPS in health-care services. Similar studies may advance the findings.

The implications for practice include NPS awareness trainings, educational updates through seminars and conferences. Participants requested clearer NPS assessment, referral and management processes. Several policy-making and procedural opportunities exist to ensure a better health outcome for people who use NPS.

To the best of the authors’ knowledge, this is the first theoretically adapted survey to explore participant’s engagements and experiences with people who use NPS in addiction and mental health settings.

Cannabis as a recreational drug is prohibited in Nigeria. Consequently, the open use of cannabis attracts both formal and informal sanctions. As such, there is much stigma on users' faces across social spaces. This has led to innovations in drug use. Recently, non-medical use of tramadol has been rising across each of the gender categories. This study aims to understand (1) tramadol use prompts, (2) the sudden surge in gendered recreational use of tramadol and (3) the gendered challenges of recreational tramadol use among Nigerian university students.

Data were collected between December 2021 and October 2022. The researcher conducted 20 semi-structured interviews, with participants chosen purposefully from acquaintances and others selected through chain referral. The selection criteria included knowledge of a particular tramadol tablet and willingness to participate. This study got ethical approval from the Anambra State Ministry of Health (Ref: MH/AWK/M/321/354) and oral consent was obtained before the interviews. The participants were assured of confidentiality. The interviews were conducted in English (the formal Nigerian language) and lasted between 30 and 65 min. The data collected were transcribed and coded manually, and themes generated.

Findings suggest that peer pressures accounted for entry-level drug use. However, cannabis-related stigma is attributed to the surge in tramadol use across gender categories. Furthermore, academic pressure and sexuality are major reasons for tramadol use. The challenges associated with tramadol use include headaches and addiction.

This study, to the best of the author’s knowledge, presents alternative data on the surge in tramadol use among Nigerian university students.