Substance use disorders affect well over 20 million Americans, and 10% of U.S. adults are estimated to have struggled with a drug use disorder at some point in their lives with most not receiving any treatment. In addition, about 21% of adults, 9% of 8th graders, and 25% of 12th graders used tobacco or vaping products in the past 30 days. Many of us have close connections with people who have experienced opioid use disorder, alcohol use disorder, nicotine addiction, and health ailments associated with these disorders – my own family has faced this across multiple generations. There is a profound lack of services available to support people suffering from substance use disorders and addiction and a need for policy change to expand access to services and support harm reduction strategies. This month we describe the groundbreaking work led by our post-doctoral fellows and faculty in the US and internationally to support positive policy change. Read on!
Joanne Spetz
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IHPS Focus On:
Substance Use and Mental Health
Many IHPS faculty are researching and working on policies related to both substance use and mental health. Laura Schmidt, PhD, MSW, MPH and Dorie Apollonio, PhD, MPP are working with Ellie Matthay, PhD on research into the effects of local cannabis control policies. Joe Guydish, PhD is exploring the use of e-cigarettes for other substances by people in substance use disorder clinics. Justin White, PhD is researching minimum price floor laws on tobacco. Jayme Congdon, MD, MS is working with elected representatives on a bill that builds on her work to break down barriers to opioid use disorder treatment for youth. Christina Mangurian, MD, MAS is exploring the mental health effects of limiting abortion access to vulnerable populations. Matt Tierney, MS, NP, FAAN works to expand the interprofessional addiction workforce. Matt is also working with Joanne Spetz, PhD, Susan Chapman, RN, PhD, FAAN, and Laura Wagner, PhD, RN, FAAN, on researching the effectiveness of federal and state policies in expanding the clinical workforce authorized to deliver OBOT via buprenorphine. Mandana Khalili, MD is looking at the effects of the Covid-19 pandemic on unhealthy alcohol use in vulnerable patients with advanced liver disease.
Learn more about some of IHPS's current work to improve health and healthcare through addressing substance use and mental health.
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California Labor Lab Webinar Series |
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Home Office Ergonomics
Post COVID-19: Carpe Diem
Carisa Harris, PhD, CPE
University of California San Francisco & Berkeley
Nov 30, 12 - 1 pm
Webinar registration link here
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IHPS Health Policy Grand Rounds
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Michelle Ko, MD, PhD
Associate Professor
Division of Health Policy and Management,
University of California,Davis
Dec 14, 12 - 1 pm
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IHPS 50th Anniversary Celebration |
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The Philip R. Lee Institute for Health Policy Studies 50th Anniversary Gala was a great success! Please go to the Flickr album below to download and tag photos. If you have any trouble accessing the folder, please email Beth Thew (beth.thew@ucsf.edu).
Photo: IHPS State of California Proclamation presentation. (l-r: Sam Hawgood, UCSF Chancellor; Joanne Spetz - IHPS Director; Scott Wiener, California State Senator)
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Brenda and Jeffrey L. Kang Presidential Chair in Health Care Financing |
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IHPS was honored to host the investiture ceremony for the Brenda and Jeffrey L. Kang Presidential Chair in Health Care Financing honoring
Joanne Spetz, PhD, on October 7, 2022.
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"Our parents would be so proud. This is a legacy that represents all of those that have followed Jeff's career. I've had to settle in places where we start over anew without friends and family; that experience has motivated me to look outward to the community, and in doing so, recognize how important it is that a strong community benefit not just ourselves but also everyone in it. The community are my friends and my family, and over the years, I've made it my mission to support it.” Brenda Lee-Kang
“I graduated from medical school here. I also am an alum of other higher institutions, but this is the school where I decided to first make a donation. UCSF is really rooted in serving the community and the disadvantages of minorities. That was really a set of values that was very important to me.” Jeff Kang
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In a recent Journal of Correctional Health Care article, Dorie Apollonio, PhD, MPP, shared the findings of her qualitative review that relied on pharmaceutical industry documents drawn from the UCSF Drug Industry Documents archive. Apollonio found that historically, both Janssen and Eli Lilly directly marketed antipsychotics to correctional facilities to increase sales, using targeted promotions and indirect “educational” advertising and by seeking control of boards that made formulary decisions. Despite multiple lawsuits regarding these practices, the settlements did not directly address marketing to correctional facilities and as a result people who are incarcerated remain at risk. These findings provide new information about industry strategies intended to target people who are incarcerated, a uniquely vulnerable population and suggest that further research on these practices is needed, along with stronger conflict-of-interest policies to reduce industry involvement on expert advisory boards that approve medications. Read more
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Buprenorphine is associated with decreased mortality from opioid use disorder, but prescribing is limited in office-based settings to clinicians with federal waivers. To expand this workforce, on April 28, 2021, the US federal government eliminated educational requirements for waivers to prescribe buprenorphine to 30 or fewer patients. In a recent JAMA Network Open article, Joanne Spetz, PhD and colleagues share their findings from a cross-sectional study. The researchers found that waiver growth during the first year after the federal education exemption was modest and concentrated among urban counties and counties with high baseline levels of clinicians with waivers. Although most growth occurred in urban areas, advanced practice nurse (APN) and physician assistant (PA) waivers accounted for more than 70% of rural growth. Their results reinforce emerging evidence that APNs and PAs play an important role in buprenorphine treatment in rural areas. Read more
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In a recent New England Journal of Medicine article, Christina Mangurian, MD, MAS and colleagues use an intersectional lens of structural racism, reproductive injustice and mental health to discuss the implications of the 2022 U.S. Supreme Court Dobbs v Jackson Women's Health Organization ruling that dismantled the constitutional right to abortion. They state although admittedly complex and highly politicized, reproductive justice, including timely and easy access to abortion, is indisputably a health care issue — a social determinant of mental (and physical) health with far-reaching repercussions. They find the implications are especially grave for birthing and pregnant people from historically marginalized groups — especially those with mental health and substance use disorders — further endangering populations that face alarmingly high pregnancy-related morbidity and mortality. Read more
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Electronic cigarettes (e-cigarettes) and vape pens designed for nicotine use can be used to consume non-nicotine substances, such as cannabis, amphetamines, cocaine, synthetic cannabinoids, and opiates. Limited data are available on other substance use in e-cigarettes (OSUE), however. In a recent Addictive Behaviors Report article, Joe Guydish, PhD and colleagues share their findings from an examination of the prevalence and predictors of OSUE in a sample of individuals in substance use disorder (SUD) treatment. Guydish and colleagues findings suggest that a substantial number SUD treatment clients may engage in OSUE. Vaping as an alternative route of administration for the consumption of non-nicotine psychoactive substances raises concerns because of the potential for serious health consequences resulting from inhaling dangerous illicit drugs of abuse, such as methamphetamine and fentanyl. For example, although injection drug use is commonly reported as the route of administration in fentanyl deaths, approximately-one-quarter of fentanyl deaths involve alternate forms of consumption such as smoking, snorting, and ingestion. Read more
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IHPS faculty are responding to policy challenges raised by the
COVID-19 pandemic with rapid-cycle research and technical assistance.
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Anthony DiGiorgio, DO, MHA is an assistant professor in the department of neurological surgery at the University of California, San Francisco. He received his DO degree from Touro University of Osteopathic Medicine in Vallejo, CA and completed neurosurgery residency at Louisiana State University Health Sciences Center in New Orleans, LA. He completed a research fellowship in minimally invasive spine surgery and a clinical fellowship in neurotrauma and neurocritical care, both at UCSF. His clinical and research interests include traumatic brain injury, spinal cord injury and minimally invasive spine surgery. He serves as Director of Spinal Neurotrauma at Zuckerberg San Francisco General Hospital and Trauma Center.
Dr. DiGiorgio also obtained a master’s in Health Administration from LSU and has served as a healthcare policy fellow in the US Senate for Bill Cassidy (R-LA). He is also a delegate to the Council of State Neurosurgical Societies representing California as well as a delegate to the California Medical Association representing San Francisco & Marin. He serves on the executive committees of both the California Association of Neurological Surgeons and the Council of State Neurological Societies. He is involved in socioeconomic and policy research, specifically Medicaid policy and access to care, serving as affiliated faculty in the Institute for Health Policy Studies at UCSF.
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Julia Adler-Milstein:
(MedScape)
Naomi Bardach:
(CalMatters)
Rita Redberg:
(Stat)
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