Addiction
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Global payment and accountable care reform efforts in the United States may connect more individuals with substance use disorders (SUD) to treatment. We tested whether such changes instituted under an Alternative Quality Contract (AQC) model within the Blue Cross Blue Shield of Massachusetts' (BCBSMA) insurer increased care for individuals with SUD. ⋯ A global payment and accountable care model introduced in Massachusetts, USA (in which a health insurer provided care providers with fixed prepayments to cover most or all of their patients' care during a specified time-period, incentivizing providers to keep their patients healthy and reduce costs) did not lead to sizable changes in substance use disorder service use during the first 3 years following its implementation.
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The use of vaporized nicotine products (VNPs), especially e-cigarettes and, to a lesser extent, pressurized aerosol nicotine products and heat-not-burn tobacco products, are being adopted increasingly as an alternative to smoking combusted products, primarily cigarettes. Considerable controversy has accompanied their marketing and use. We propose a framework that describes and incorporates patterns of VNP and combustible cigarette use in determining the total amount of toxic exposure effects on population health. ⋯ We then present the framework and define different measures of VNP use; namely, trial and long-term use for exclusive cigarette smokers, exclusive VNP and dual (cigarette and VNP) use. Using a systems thinking framework and decision theory we considered potential pathways for current, former and never users of VNPs. We then consider the evidence to date and the probable impacts of VNP use on public health, the potential effects of different policy approaches and the possible influence of the tobacco industry on VNP and cigarette use.
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Given the potential to expand naloxone supply through community pharmacy, the aim of this study was to estimate Australian pharmacists': (1) level of support for overdose prevention, (2) barriers and facilitators for naloxone supply and (3) knowledge about naloxone administration. ⋯ Community pharmacists in Australia appear to be willing to supply naloxone. Low levels of knowledge about naloxone pharmacology and administration highlight the importance of training pharmacists about overdose prevention.
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Brands are critical to tobacco marketing. Industry stakeholders predicted that plain packaging, by removing key tangible branding dimensions, would restrict new products and brand differentiation. However, manufacturers respond innovatively to limit regulatory impact. This study investigates brand strategy following plain packaging's introduction to Australia. ⋯ New brands and variants were not inhibited by the introduction of plain packaging in Australia. After plain packaging, leading brand variant numbers expanded by 9 to 116 and colour variant names increased by 73.6% and became the norm-lighter colours (blue, gold and silver) dominated, perpetuating notions of less harmful cigarettes. [Correction added on 09 September 2016, after first online publication: The figures in the last sentence of the Abstract are now corrected from 'expanded by 116' to 'expanded by 9 to 116'.].