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Public Health News Watch Wednesday: Report for March 29, 2017

Folk/rock singer Neil Young decried the personal harm and collateral damage caused by injection drug use in his song “The Needle and the Damage Done.”
In a sense, nearly 25 years after the song’s release, he could add a new verse regarding healthcare reform.
Indeed, it seems, based on recent media reports, that the latest epidemic of injection drug abuse in the United States played a role in derailing President Trump’s attempts to “repeal and replace” the Affordable Care Act (ACA), otherwise known as “Obamacare.” At issue, specifically, was the provision of the proposed legislation that, over the next 10 years, would have, according to Congressional Budget Office figures, cut Medicaid funding by $839 billion and, ultimately, lead to 14 million Americans being dropped from the rolls of the government-administered program.
An article published in The New York Times on March 28, 2017 noted that several “moderate” Republicans went against their colleagues in Congress and the GOP-controlled White House due, in large part, to the effect the changes in Medicaid would have had with regard to the opioid epidemic in their districts. In recent years, multiple states—including Virginia, Massachusetts, Kentucky, and West Virginia—have cited significant problems with opioid use.
A study published March 29, 2017 in JAMA Psychiatry found that the number of heroin users and those with heroin use disorder in the United States increased significantly (by nearly 5 times) during the period of 2001 through 2013. In their survey of 79,402 adults, the researchers from the Columbia University Mailman School of Public Health found that the prevalence of heroin use increased from 0.33% in the time period 2001-2002, to 1.61% in 2012-2013. The prevalence of heroin use disorder increased from 0.21% to 0.69% over the same period.
Although, Young didn’t mention infectious diseases in “The Needle…,” he very well could have. Opioid abuse in general, and injection drug use, specifically, have been linked with a number of public health challenges, including the spread of HIV and hepatitis C. Recently, as we reported in Contagion®, increased non-prescription opioid use has been linked with case clusters of HIV in Kentucky, Tennessee, and West Virginia, among others, based on an analysis performed by the Centers for Disease Control and Prevention. In addition, a report published by the Brookings Institute this month, suggests that this particularly high-risk and harmful drug use may, in fact, be the result of “poorer health and mental health, social isolation, obesity, marriage (or lack of marriage), poorer labor market opportunities, and weaker attachment to the labor market,” the authors told the Guardian.

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