Federal Policy Changes Research Articles

55 The Effect of Federal Policy Changes on Buprenorphine Prescribing in Massachusetts

55 The Effect of Federal Policy Changes on Buprenorphine Prescribing in Massachusetts

Attitudinal barriers to buprenorphine prescription and former waiver training.

Opioid use disorder (OUD) can be effectively treated with buprenorphine maintenance. Recent changes in federal policy have removed the requirement for physicians to complete additional training to apply for a Drug Enforcement Administration (DEA) waiver to prescribe buprenorphine. At that time, few primary care providers (PCPs) had completed the training for a DEA waiver to prescribe buprenorphine. Our goal was to identify addressable barriers that may persist despite updates to federal legislation. A 42-item survey was distributed to 662 physicians and nurse practitioners at two academic medical centers with 100 respondents. The survey was sent via email and administered anonymously through SurveyMonkey. All participants were PCPs, and all PCPs at the two academic medical centers were eligible to participate. PCPs responded to the survey by answering questions online. PCPs answered questions regarding previous buprenorphine waiver training status, local OUD prevalence, the effectiveness of OUD treatment modalities, and previous barriers to training. Respondents were compared using descriptive statistics and logistic regression. Of the 100 respondents (response rate: 15 percent), 69 percent had not completed the training. Ninety-nine percent of PCPs agreed that OUD was an issue in their area, 94 percent saw patients with OUD, and 91 percent rated buprenorphine maintenance as a very effective treatment for OUD. Previously waivered and nonwaivered providers did not differ in their responses to these questions. Those who had been waivered were less likely to say they did not see enough patients with OUD to justify training (odds ratio [OR] 0.267, p = 0.005) and were less likely to express concern about allowing patients with OUD into their practice (OR 0.348, p = 0.020) than PCPs who had applied for the DEA waiver. Despite nonwaivered PCPs recognizing OUD's prevalence, they were concerned about allowing patients with OUD into their practice and said there were not enough patients to justify training. This suggests that attitudinal barriers are the most appropriate target for current intervention.

Educational Debt and Income Among Pharmacists and Other Health Professionals

ObjectiveGiven the substantial increases in student educational loan debt in recent years, the objective was to assess trends in educational debt-to-income ratios for graduates of pharmacy, medicine, dentistry, optometry, and veterinary medicine programs in the United States in the 2017–2022 period. MethodsA retrospective analysis of 2017–2022 data for educational debt and income for select health professions was conducted. Annual income data were collected from the American Community Survey, and educational debt data were collected from health professions organizations. Educational debt-to-income ratios for each health profession were calculated, as was the mean change per year in debt-to-income ratio. ResultsWith the exception of medicine, educational debt consistently exceeded income across the selected health professions in the 2017–2022 period. Debt-to-income ratios of pharmacists and the remaining health professionals decreased on average per year between 2017 and 2022. Physicians had the lowest debt-to-income ratios and dentists had the highest debt-to-income ratios in the study period. ConclusionDebt-to-income ratios fell below the 2017 levels for the health professions of interest, suggesting that average growth in income outpaced that of debt for the study period. Regardless, debt remains high and may influence health care professionals’ postgraduate training and career decisions, and in turn affect access to health care. Therefore, a call to action is proposed to address educational debt burden. Several strategies are suggested, including federal policy changes, implementing tuition reductions or minimal increases, facilitating financial aid options, and reducing underlying costs of health professions programs.

Structural Racism in Newborn Drug Testing: Perspectives of Health Care and Child Protective Services Professionals.

Black birthing parents and their newborns disproportionately experience newborn drug testing for prenatal substance exposure by health care professionals (HCPs), which contributes to Child Protective Services (CPS) reporting, family separation, and termination of parental rights. This qualitative study aims to interrogate dominant power structures by exploring knowledge, attitudes, and experiences of HCPs and CPS professionals regarding the influence of structural racism on inequities in newborn drug testing practices. We conducted semistructured interviews with 30 physicians, midwives, nurses, social workers, and CPS professionals guided by an explanatory framework, and conducted inductive, reflexive thematic analysis. We identified 3 primary themes: (1) levels of racism beyond the hospital structure contributed to higher rates of drug testing for Black newborns; (2) inconsistent hospital policies led to racialized application of state law and downstream CPS reporting; and (3) health care professionals knowledge of the benefits and disproportionate harms of CPS reporting on Black families influenced their decision making. Health care professionals recognized structural racism as a driver of disproportionate newborn drug testing. Lack of knowledge and skill limitations of HCPs were barriers to dismantling power structures, thus impeding systems-level change. Institutional changes should shift focus from biologic testing and reporting to supporting the mutual needs of birthing parent and child through family-centered substance use treatment. State and federal policy changes are needed to ensure health equity for Black families and eliminate reporting to CPS for prenatal substance exposure when no concern for child abuse and neglect exists.

Why Do Universities Outsource Management of Their Online Programs?

ABSTRACT The U.S. online program manager (OPM) market has grown substantially in the past decade, as many colleges and universities have sought third-party servicers to help expand and develop their online offerings. Yet, the approach of contracting with OPMs has raised concerns of policymakers, think tanks, higher education critics, and even some campus leaders – with discussions and advocacy of federal policy changes governing higher education’s use of third-party servicers. To understand why universities engage with these for-profit companies, despite the extensive criticisms they have received, we examined the drivers to outsource with OPMs as an organizational strategy. Findings suggest four primary drivers that comprise the College Curation Strategy Framework: react to competitive pressures with speed; access initial, upfront capital; address gaps in capacity and capabilities; and learn and scale-up in house. This framework may help guide decision making when HEIs consider outsourcing. Implications for research and practice are discussed.

Evolution of Professional Standards: Reflecting on the Past to Inform the Future

Clearly defined professional standards result in better prepared professionals who positively impact outcomes for children and families by ensuring an effective workforce. This article describes the evolution of early intervention early/childhood special education preparation standards from the on-the-job competencies of the 1960s to the historic 2020 Initial Practice-Based Professional Standards for Early Interventionists/Early Childhood Special Educators (EI/ECSE Standards), in concert with the evolution of the profession itself. Influencing factors include (a) changes in federal legislation and policy, (b) ages and characteristics of children served, (c) growing knowledge of effective practices, (d) collaboration with other disciplines, and (e) ongoing advocacy for EI/ECSE as a profession. The article concludes with a vision for using these EI/ECSE Standards to guide the future local, state, and national agenda of the profession around preservice preparation and accreditation, professional development, state and federal policy, cross-disciplinary collaboration, and standards-informed research.

Policy whiplash: How California Title IX coordinators navigated local, state, and federal policy changes during the Trump administration

AbstractFederal Title IX policy requires institutions of higher education (IHEs) to prevent and respond to sexual misconduct. Based on 23 in‐depth interviews, this study explores California Title IX coordinator experiences at a critical policy juncture—the recension of the Obama‐era guidance and the implementation of the Trump administration Title IX rules and regulations—to understand how they responded to, implemented, or resisted federal mandates. Most California Title IX officers reported that the recension of Obama guidelines had limited impact on their daily operations because they lived in a state with more progressive social policy. Participants singled out California case law, state statues, the California Education Code and university system mandates as protective legislation to ensure survivors’ rights. By contrast, the new Title IX regulations that became law in August 2020 were perceived as more consequential. The tight implementation time frame, combined with the complicated and unfunded policy directives, imposed heavy burdens on their administrative offices. Title IX officers foresaw implementation consequences to campus safety, survivors’ willingness to report, and to the credibility of the Title IX office. Taken together, their experiences lend support to progressive state legislative action, restorative justice approaches and for a survivor bill of rights as important counterpoints to federal Title IX policy.

Methadone Prescribing Regulation for Opioid Use Disorder in Canada: Evidence for an East-West Policy Divide.

Opioid agonist therapy (OAT) is a key element in the response to opioid-related harms in Canada. In May 2018, Health Canada rescinded the requirement for obtaining a federal exemption for methadone prescribing. This comparative analysis examined provincial OAT policies and policy changes in response to this federal policy change. Policies and changes were regionalized; despite having lower rates of opioid-related harms, eastern provinces had looser regulatory regimes compared with western provinces, which became even looser after the federal policy change. Diverse knowledge and policy networks need to be fostered to bridge this east-west divide in substance use care policy.

(Dis)honorably discharged: identifying policy gaps in military-civilian reintegration.

Despite the substantial transition assistance available for honorably separating servicemembers, 75% of US veterans report difficulties with the transition to civilian life. For the 16% of veterans who separate with less-than-honorable discharges, these difficulties are compounded by the lack of structural support from the US military. Social stigma, limited transition programming, and loss of benefits create a perfect storm of barriers for these discharged servicemembers. These barriers compound with post-service mental and physical health challenges to contribute to cycles of misconduct that can result in criminal incarceration. Further, because most of these veterans lack health benefits from the Department of Veterans Affairs due to their discharge status, this population is substantially understudied from a public health perspective. However, actionable policy paths forward and federal policy change offer opportunity to soften the landing for these veterans and meet their legitimate needs for care.

Reported exposures to derived cannabis products in California before and after the 2018 federal reclassification of hemp

BackgroundAs of June 2023, a majority of states had legalized the sale of cannabis, which past research has found to be associated with increased exposures. In 2018, a change in federal policy increased access to cannabidiol (CBD) and derived psychoactive cannabis products, but there has been limited study of reported exposures following this change. MethodsThis observational retrospective study analyzed exposures involving synthetic cannabinoid receptor agonists (SCRAs) and derived cannabis products, including CBD, reported to the California Poison Control System (CPCS) from 2010 to 2022. We focused primarily on potential shifts in reported exposures before and after the implementation of the 2018 Farm Bill, which removed products derived from hemp from the Controlled Substances Act. We reviewed and hand-coded individual call records to assess reported exposures over time and their characteristics, and conducted interrupted time series analysis to assess whether exposure counts changed after policy interventions. ResultsReported CBD exposures significantly increased following the federal reclassification of hemp products. Exposure reports were most common among young children and for edibles. Exposure reports provided limited information about derived psychoactive cannabis products. ConclusionsOur findings suggest a need for improved data collection regarding derived psychoactive cannabis products, as well as potential public health value in modifying packaging regulations and in providing additional guidance to parents to help prevent CBD exposures.

Adoption of methadone take home policy by U.S. state opioid treatment authorities during COVID-19

BackgroundPatients face well documented problems accessing methadone from opioid treatment programs (OTPs) in the U.S., yet addressing these barriers has proven difficult due in part to the sheer number of actors governing treatment, including state authorities. Changes in federal methadone regulations during COVID-19 offer an opportunity to study the timing and extent of U.S. state opioid treatment authority (SOTA) adoption of policies expanding take home dosing for methadone treatment since March 2020. MethodsWe completed a policy scan between February 23 and May 2, 2023 on state adoption and subsequent rescinding of federal regulatory exemptions for expanded take-home dosing. This scan involved three components: a policy survey of SOTAs, a freedom of information act (FOIA) request of SAMHSA, and outreach to members of National Survivors Union (NSU)’s methadone work group. ResultsOf the 39 of 50 (78 %) SOTAs that responded, only 2 states (HI and MT) indicated that they never adopted federal exemptions for expanded take-home dosing. Of the 37 adopting states, all adopted the exemptions within the first month after the agency's announcement. Additionally, four SOTAs (OH, IN, FL, MS) indicated that their state subsequently rescinded expanded take-home dosing for methadone. ConclusionsAmong responding states, regulations expanding take-home dosing appear to have been adopted by U.S. SOTAs in a widespread and rapid manner at the start of the COVID-19 pandemic, but some states have begun to rescind such policies. Our findings suggest that state regulators can rapidly modify OTP regulations in response to federal policy changes. SOTA policies are likely to become critical factors in the adoption of methadone treatment innovations if new federal regulatory flexibilities become permanent.

Policies addressing suspension and expulsion in state early care and education subsystems: A national census of policy alignment and integration

Exclusion from early care and education (ECE) programs creates employment challenges for families and disrupts learning for children, often differentially impacting children placed at-risk due to income, race, and disability. Federal policy guidance and changes in the Child Care and Development Fund (CCDF) Block Grant requirements are meant to influence states to create policies that will both regulate and prevent disciplinary exclusions, especially suspension and expulsion. We present a national census of states’ CCDF plans, center-based child care licensing regulations, and state pre-K policies addressing suspension and expulsion. Using content analysis methodology, we evaluate the presence of key policy components of suspension and expulsion prevention including data collection, parent/family involvement in the process of exclusions, accessing community resources, and the use of developmental information to inform the use of exclusionary discipline. Our results indicate that expulsion and suspension policies vary widely both across states, and within the same state's subsystems. The component found most frequently across all subsystems is an expulsion policy, with noticeable variation in specifying and defining suspension. Our findings also point to a great deal of variance in policy alignment, with pre-K including the most information on expulsion and suspension policies and prevention. As state-level policymakers seek to adopt policies that reduce exclusion in ECE, our findings point to a need to consider the importance of creating policies that protect children, especially those over exposed to exclusionary discipline, and then aligning those components within and across ECE subsystems to promote equitable access to ECE. This is particularly important for low-income families, Black children, children with disabilities, and boys.

Assessing past and future COVID-19 vaccine hesitancy in the United States in light of federal policy changes.

Vaccinations provide an effective solution against the ongoing COVID-19 pandemic. Using a national survey (n = 3958), this study explored vaccination hesitancy for various COVID-19 vaccines and boosters, including the newly released annual vaccine for fall and winter 2023-2024. It also assessed support for federal funding for COVID-19 testing, vaccinations, and treatment. Consistent correlates of past vaccination refusal were perceptions of vaccines as safe and important, previous COVID-19 tests, concern about COVID-19, having voted for President Trump, higher religiosity, being liberal, trust in health institutions, health insurance status, and education. Other predictors showed inconsistent results across the various stages. Drivers of vaccination refusal were concerns about vaccine safety and side effects, perceived lack of information, and having previously contracted COVID-19. Intention to vaccinate was associated with concerns about COVID-19, liberalism, and trust in health institutions. Other factors were intermittently significant. We found consistent support for federal funding for those concerned about COVID-19, those concerned about the effectiveness of existing vaccines, those with trust in health institutions, those who thought vaccines are important, women, and those with lower levels of education. Opposition came from conservatives and Trump voters.

러시아연방 주체 타타르스탄의 민족-언어 문제 연구

Tatarstan, which declared independence on August 30, 1990, a year before the dissolution of the Soviet Union, gained equal status with 15 federal republics and further promoted sovereign independence, but remained as a national republic in the Russian Federation through a treaty with the Russian Federation in February 1994.
 In the process of gaining sovereignty, the Tatar language law was enacted in July 1992, the Tatar language was established as a national language along with Russian, a 10-year republic-level program was enacted in April 1994, and the Latin Translation Act was adopted in September 2001.
 But the push for linguistic independence was only natural, causing discontent and confusion among Russians and other Russian-speaking minorities, with the indigenous-led Tatar population barely exceeding half of the republic's population, and causing checks from the Russian federal government. In particular, parents' dissatisfaction with the decline in Russian education time due to the increase in the number of Tatar education hours in school education has increased, and the negative effects of text replacement, such as the possibility of interaction with Turkey in the Muslim-led ethnic republic.
 This eventually resulted in the addition of Russian to the list of more languages, allowing all ethnic republics to learn Russian in more education classes, and allowing only Cyril-based notation to be established. It was a change in the Russian federal government's ethnic-language policy, concerned about the enormous influence of the establishment and expansion of the identity of the Tatar and the Tatar languages, the most populous and traditional ethnic minorities in the Russian Federation.

Caught Between a Well-Intentioned State and a Hostile Federal System: Local Implementation of Inclusive Immigrant Policies.

In the United States, inclusive state-level policies can advance immigrant health and health care access by extending noncitizens' access to public benefits, workplace rights, and protections from immigration enforcement. Although state policies carry promise as structural population health interventions, there has been little examination of their implementation at the local level. Local jurisdictions play multiple roles in state policy implementation and possess distinct immigration climates. Examining the local implementation of state immigrant policy can address challenges and opportunities to ensure the health benefits of inclusive policies are realized equitably across states' regions. To examine the local implementation of state immigrant policies, we selected a purposive sample of California counties with large immigrant populations and distinct social and political dynamics and conducted and analyzed in-depth interviews with 20 community-based organizations that provided health, safety net, and other services. We found that there were tensions between the inclusionary goals of state immigrant policies and local anti-immigrant climates and federal policy changes. First, there were tensions between state policy goals and resistance from local law enforcement agencies and policymakers (e.g., Board of Supervisors). Second, because of the ongoing threats from federal immigration policies, there was a mismatch between the services and resources provided by state policies and local community needs. Finally, organizations that served immigrants were responsible for contributing to policy implementation but lacked resources to meet community needs while countering local resistance and federal policy threats. This study contributes knowledge regarding the challenges that emerge after state immigrant policies are enacted. The tensions among state immigrant policies, local immigration climates, and federal policy changes indicate that state immigrant policies are not implemented equally across state communities, resulting in challenges and limited benefits from policies for many immigrant communities.

Covid-19: Home Health Aides' Perceived Preparedness and Self-Reported Availability for Work: Six Month Survey Results.

Throughout the COVID-19 pandemic New York City home health aides continuously provided care, including to patients actively infected or recovering from COVID-19. Analyzing survey data from 1316 aides, we examined factors associated with perceptions of how well their employer prepared them for COVID-19 and their self-reported availability for work (did they "call out" more than usual). Organizational work environment and COVID-19-related supports were predominant predictors of self-reported perceptions of preparedness. Worker characteristics and COVID-19-related stressors were predominant predictors of self-reported availability. Mental distress, satisfaction with employer communications, and satisfaction with supervisor instructions were significantly associated with both outcomes. The study uniquely describes self-reported perceptions of preparedness and availability as two separate worker outcomes potentially modifiable by different interventions. Better public health emergency training and adequate protective equipment may increase aides' perceived preparedness; more household supports could facilitate their availability. More effective employer communications and mental health initiatives could potentially improve both outcomes. Industry collaboration and systemic changes in federal, state, and local policies should enhance intervention impacts.

Lessons Learned from the U.S. Public Health Response to the 2022 Mpox Outbreak.

In mid-2022, an Mpox outbreak occurred in the United States and more than 100 countries, disproportionately affecting men who have sex with men (MSM). Initially, the U.S. public health system failed to deploy tests, treatment, and vaccines effectively. Key federal policy changes in August 2022, along with risk reduction among many MSM, led to a steady reduction in new diagnoses by December 2022. Mpox outbreaks occurred among MSM in Chicago and France in May 2023, and vaccination rates remain low. This perspective analyzes the U.S. response to the 2022 outbreak, and it identifies the lessons learned that may guide Mpox management moving forward.

Racial, Ethnic, and Sex Differences in Methadone-Involved Overdose Deaths Before and After the US Federal Policy Change Expanding Take-home Methadone Doses

In March 2020, the Substance Abuse and Mental Health Services Administration (SAMHSA) permitted states to relax restrictions on take-home methadone doses for treatment-adherent patients to minimize COVID-19 exposures. To assess whether the methadone take-home policy change was associated with drug overdose deaths among different racial, ethnic, and sex groups. Interrupted time series analysis from January 1, 2018, to June 30, 2022. Data analysis was conducted from February 18, 2023, to February 28, 2023. In this population-based cohort study of drug overdose mortality including 14 529 methadone-involved deaths, monthly counts of methadone-involved drug overdose deaths were obtained for 6 demographic groups: Hispanic men and women, non-Hispanic Black men and women, and non-Hispanic White men and women. On March 16, 2020, in response to the first wave of the COVID-19 pandemic, SAMHSA issued an exemption to the states that permitted up to 28 days of take-home methadone for stable patients and 14 days for less stable patients. Monthly methadone-involved overdose deaths. From January 1, 2018, to June 30, 2022 (54 months), there were 14 529 methadone-involved deaths in the United States; 14 112 (97.1%) occurred in the study's 6 demographic groups (Black men, 1234; Black women, 754; Hispanic men, 1061; Hispanic women, 520; White men, 5991; and White women, 4552). Among Black men, there was a decrease in monthly methadone deaths associated with the March 2020 policy change (change of slope from the preintervention period, -0.55 [95% CI, -0.95 to -0.15]). Hispanic men also experienced a decrease in monthly methadone deaths associated with the policy change (-0.42 [95% CI, -0.68 to -0.17]). Among Black women, Hispanic women, White men, and White women, the policy change was not associated with a change in monthly methadone deaths (Black women, -0.27 [95% CI, -1.13 to 0.59]; Hispanic women, 0.29 [95% CI, -0.46 to 1.04]; White men, -0.08 [95% CI, -1.05 to 0.88]; and White women, -0.43 [95% CI, -1.26 to 0.40]). In this interrupted time series study of monthly methadone-involved overdose deaths, the take-home policy may have helped reduce deaths for Black and Hispanic men but had no association with deaths of Black or Hispanic women or White men or women.

Reducing Drug Overdose Deaths: Significant Changes Needed in U.S. Drug Treatment Policy.

Slow and incremental changes in federal and state drug policies are neither meeting treatment needs nor reversing yearly increases in drug-related mortality. U.S. drug policies convey confounding messages that non-sanctioned substance use leads to health problems that need treatment while simultaneously being legal problems that must be punished. As a result, drug treatments remain a sequestered component of health care, with onerous treatment requirements for patients and providers that act as barriers to the treatment that policies seek to allow. A new direction in drug policy is needed that broadens rather than restricts access to care and that also focuses on prevention. Policies must consider the totality of health and wellness, not just "last resort" safety nets for urgent needs. For substantive change in drug-related morbidity and mortality, forward-thinking policy must focus more on addiction prevention and address the known risks of developing a substance use disorder. [Journal of Psychosocial Nursing and Mental Health Services, 61(6), 7-10.].

The Global Financial Crisis: Cause and Regulatory Response

This paper explores the connections between the 1930s Great Depression and the 2008 Financial Crisis. It also goes into great detail regarding the causation, consequences, and changes that surrounding the 2008 Great Recession. Particularly, the change in federal monetary policy during the early 2000s saw a spike in the amount of loans and mortgages. Accompanied by the positive expectations and aspirations of the investors, the housing market boomed. As a result, financial derivatives of asset-backed securities also flooded the market. In the end, this over-inflation of the housing market and its derived products created a housing bubble, which ultimately led to a catastrophic financial crisis when too high a leverage and inability of borrowers to pay back loans burst this overly-optimistic bubble. Upon the occurrence of this financial crisis, new policies were enacted and acts were set in place. Through interpreting the findings of 2022’s Nobel prize winning economists, individuals and groups alike are able to protect themselves from inevitable financial crises that take place in the future.