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The Opioid Epidemic: From Evidence to Impact

October 25, 2017

The growing crisis of the U.S. opioid epidemic affects all of us, not just those caught in its grip. It is destroying lives, ripping families apart, weakening our communities, and preventing our country from taking full advantage of our greatest resource – our people. We ignore the problem at our peril. We can't afford to lose a single person. There is no single solution to this grave public health threat, but we know where to start. First, we must acknowledge that opioid addiction is a disease that requires comprehensive treatment. Closing the path to addiction means addressing the overprescription of legal opioids and the proliferation of illegal opioids such as heroin and drugs laced with fentanyl. We also have to build the public health response so that families, first responders, and community groups have the support necessary to turn the tide on the epidemic, and in the meantime don't have to bear an impossible economic and emotional burden. This report contains specific, proven recommendations for how to most effectively combat the epidemic – from allowing physicians to more effectively treat those suffering from addiction; to expanding coverage and accessibility of opioid overdose reversal drugs like naloxone; to changing the way that healthcare professionals, employers, and advocates talk about addiction to reduce stigma. These recommendations are a critical map for everyone working to fight the opioid crisis in America. We all have a part to play. At the Clinton Foundation, we have worked since 2012 to help prevent overdose deaths, increase awareness and understanding of the scale of the problem, and frame this as a public health issue. Moving forward, it's up to all of us – leaders from the advocacy, nonprofit, government, and business sectors – to act together. By prioritizing this issue and advancing these recommendations, we can prevent more lives from being lost to this epidemic and ensure a brighter future for all Americans.

The Transmission of Gun and Other Weapon-Involved Violence Within Social Networks

January 5, 2016

Fatal and nonfatal injuries resulting from gun violence remain a persistent problem in the United States. The available research suggests that gun violence diffuses among people and across places through social relationships. Understanding the relationship between gun violence within social networks and individual gun violence risk is critical in preventing the spread of gun violence within populations. This systematic review examines the existing scientific evidence on the transmission of gun and other weapon-related violence in household, intimate partner, peer, and co-offending networks. Our review identified 16 studies published between 1996 and 2015 that suggest that exposure to a victim or perpetrator of violence in one's interpersonal relationships and social networks increases the risk of individual victimization and perpetration. Formal network analyses find high concentrations of gun violence in small networks and that exposure to gun violence in one's networks is highly correlated with one's own probability of being a gunshot victim. Physical violence by parents and weapon use by intimate partners also increase risk for victimization and perpetration. Additional work is needed to better characterize the mechanisms through which network exposures increase individual risk for violence and to evaluate interventions aimed at disrupting the spread of gun and other weapon violence in high-risk social networks.

The Prescription Opioid Epidemic: an Evidence-Based Approach

November 12, 2015

A group of experts, led by researchers at the Johns Hopkins Bloomberg School of Public Health, issued this report aimed at stemming the prescription opioid epidemic, a crisis that kills an average of 44 people a day in the U.S. The report calls for changes to the way medical students and physicians are trained, prescriptions are dispensed and monitored, first responders are equipped to treat overdoses, and those with addiction are identified and treated. The report grew out of discussions that began last year at a town hall co-hosted by the Bloomberg School and the Clinton Health Matters Initiative, an initiative of the Clinton Foundation. The recommendations were developed by professionals from medicine, pharmacy, injury prevention and law. Patient representatives, insurers and drug manufacturers also participated in developing the recommendations. The report breaks its recommendations into seven categories:Prescribing GuidelinesPrescription Drug Monitoring Programs (PDMPs)Pharmacy Benefit Managers (PBMs) and PharmaciesEngineering Strategies (i.e., packaging)Overdose Education and Naloxone Distribution ProgramsAddiction TreatmentCommunity-Based Prevention Strategies

Estimating variability in the transmission of severe acute respiratory syndrome to household contacts in Hong Kong, China.

May 10, 2007

The extensive data collection and contact tracing that occurred during the 2003 outbreak of severe acute respiratory syndrome (SARS) in Hong Kong, China, allowed the authors to examine how the probability of transmission varied from the date of symptom onset to the date of hospitalization for household contacts of SARS patients. Using a discrete-time likelihood model, the authors estimated the transmission probability per contact for each day following the onset of symptoms. The results suggested that there may be two peaks in the probability of SARS transmission, the first occurring around day 2 after symptom onset and the second occurring approximately 10 days after symptom onset. Index patients who were aged 60 years or older or whose lactate dehydrogenase level was elevated upon admission to the hospital (indicating higher viral loads) were more likely to transmit SARS to their contacts. There was little variation in the daily transmission probabilities before versus after the introduction of public health interventions on or around March 26, 2003. This study suggests that the probability of transmission of SARS is dependent upon characteristics of the index patients and does not simply reflect temporal variability in the viral load of SARS cases.