JAMA Network Open

BackgroundAccess to medications for opioid use disorder (MOUD) in the U.S. is highly restricted. In March 2020, to reduce transmission of COVID-19, SAMHSA issued emergency regulations allowing up to two weeks of take-home doses for most patients. ObjectivesWe evaluated the benefits and unintended consequences of these new regulations expanding take-home eligibility to inform MOUD policy post-pandemic MethodsWe conducted a mixed-methods evaluation of an opioid treatment program in San Francisco...

ObjectivesThe objective of this study was to investigate whether healthcare visits initiated by telehealth had higher or lower 30-day spending compared to in-person-initiated visits. The study compared the overall spending, rates of return visits, laboratory tests, and imaging procedures within 30 days for Medicare fee-for-service patients who underwent in-person and telehealth evaluations between July 1, 2020 and December 31, 2022. Study DesignA large-scale retrospective cohort study using pro...

BackgroundOff-patent, generic drugs are expected to be widely accessible owing competitive pricing and minimal R&D costs. Sudden, excessive, unexplainable, and sustained price increases detrimentally impact the health and welfare of patients and their families. Overlooking such cases encourages repeat behavior that may be legislatively challenging to overcome, thereby impeding the principle of democratization of medicines propagated by the expiration of patent protection. FindingsWe analyzed Me...

An essential precondition for successful "herd immunity" strategies for the control of SARS-CoV-2 is that reinfection with the virus be relatively rare. Some infection control, prioritization, and testing strategies for SARS-CoV-2 were designed on the premise of rare re-infection. The U.S. Veterans Health Administration (VHA) includes 171 medical centers and 1,112 outpatient sites of care, with widespread SARS-CoV-2 test availability. We used the VHAs unified, longitudinal electronic health reco...

BackgroundBetween 2017 and 2020, Ontario implemented overdose prevention sites (OPS) and consumption and treatment services (CTS) in nine of its 34 public health units (PHU). We tested for the effect of booth-hours (spaces within OPS/CTSs for supervised consumption) on opioid-related health service use and mortality rates at the provincial-(aggregate) and PHU-level. MethodsWe used monthly rates of all opioid-related emergency department (ED) visits, hospitalizations, and deaths between January ...

ImportanceSevere acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection causes coronavirus disease 2019 (Covid-19), an evolving pandemic. Limited data are available characterizing SARS-Cov-2 infection in the United States. ObjectiveTo determine associations between demographic and clinical factors and testing positive for coronavirus 2019 (Covid-19+), and among Covid-19+ subsequent hospitalization and intensive care. Design, Setting, and ParticipantsRetrospective cohort study includin...

Although coronavirus disease 2019 (COVID-19) emerged in January 2020, there is no quantified effect size for non-pharmaceutical interventions (NPI) to control the outbreak in the continental US. Objective. To quantify national and sub-national effect sizes of NPIs in the US. Design. This is an observational study for which we obtained daily county level COVID-19 cases and deaths from January 22, 2020 through the phased removal of social distancing protections. A stepped-wedge cluster-randomized ...

PurposeIncreases in pediatric firearm-related injuries during the COVID-19 pandemic may be due to changes in where children and adolescents spent their time. This paper examines changes in the frequency of pediatric firearm-related encounters as a function of schooling mode overall and by race/ethnicity and age group at a large trauma center through 2021. MethodsWe use data from a large pediatric and adult trauma center in Tennessee from January 2018 to December 2021 (N=211 encounters) and geog...

Remdesivir has been granted emergency use authorization for treatment of severe COVID-19. Remdesivir's pricing is based on a presumed reduction of hospital length of stay (LOS) by four days. But the Adaptive COVID-19 Treatment Trial (ACTT-1) that suggested this treatment benefit excluded patients who were expected to be discharged within 72 hours. Perhaps as a result, median time to recovery was unusually long in both arms of the study (15 days vs 11 days). Remdesivir requires a 5-day inpatient ...

BackgroundThe coronavirus disease-19 (COVID-19) pandemic threatens to overwhelm the healthcare resources of the country, but also poses a personal hazard to healthcare workers, including physicians. To address the potential impact of excluding physicians with a high risk of adverse outcomes based on age, we evaluated the current patterns of age of licensed physicians across the United States. MethodsWe compiled information from the 2018 database of actively licensed physicians in the Federation...

BackgroundThe 340B Drug Pricing Program was established to expand access to care for low-income and uninsured patients by allowing safety-net hospitals and clinics to purchase outpatient drugs at discounted prices. Over time, the program has expanded substantially, raising questions about whether participating hospitals are meeting the programs intended objectives. MethodsUsing 2023 hospital financial data from the RAND Corporation, we conducted cross-sectional descriptive comparisons of 340B a...

IntroductionTelehealth expanded rapidly following the COVID-19 pandemic and has become an integral part of healthcare delivery. However, concerns remain that increased telehealth availability may contribute to higher overall healthcare utilization and spending. To assess telehealths impact on outpatient evaluation and management (E&M) visit volume, we compared overall E&M utilization before and after the pandemic across specialties with varying levels of telehealth use. MethodsWe analyzed 100% ...

Machine learning and artificial intelligence (AI/ML) models in healthcare may exacerbate health biases. Regulatory oversight is critical in evaluating the safety and effectiveness of AI/ML devices in clinical settings. We conducted a scoping review on the 692 FDA 510k-approved AI/ML-enabled medical devices to examine transparency, safety reporting, and sociodemographic representation. Only 3.6% of approvals reported race/ethnicity, 99.1% provided no socioeconomic data. 81.6% did not report the a...

BackgroundLong-acting injectable buprenorphine (LAI-BUP) is safe and effective, however is dramatically underutilized in comparison to oral formulations. Little is known regarding how buprenorphine prescribers view LAI-BUP, and which medication attributes they prioritize when selecting treatment for opioid use disorder (OUD). MethodsA secondary analysis of a national, cross-sectional online survey of U.S. physicians who prescribe buprenorphine for OUD was conducted. Respondents reported OUD cas...

BackgroundIn a profound reversal of prior trends, U.S. drug overdose deaths declined by 26.9% in 2024. Two proposed explanations are: (1) expansion of prevention, treatment, and harm-reduction infrastructure and (2) changes in the illicit fentanyl supply. This study evaluated which hypothesis best aligns with observed changes in drug involvement in overdose mortality. MethodsCDC WONDER multiple-cause-of-death data for 2023 and 2024 were analyzed using complementary approaches. In a preliminary ...

Emergency department (ED) triage decisions critically impact patient care and are standardized, yet ethnoracial disparities in triage assignment are well documented. We analyzed ethnoracial differences in triage assignments across four U.S. EDs (two adult, two pediatric), comprising 1.4 million encounters from 2011-2025. To better characterize these disparities, we developed an automated triage algorithm that replicates the Emergency Severity Index (ESI) criteria, the standard triage protocol us...

AimsBuprenorphine is an opioid partial-agonist used to treat Opioid Use Disorders (OUD). While several state and federal policy changes have attempted to increase buprenorphine availability, access remains well below optimal levels. This study characterized how buprenorphine utilization in the United States has changed over time and whether there are regional disparities in distribution. MeasurementsBuprenorphine weights distributed from 2007 to 2017 were obtained from the Drug Enforcement Admi...

AimsTo characterize decreases in overdose mortality in the United States between 2023 and 2024 by substance involvement, geography, race/ethnicity, demographic, and other key dimensions. DesignPopulation-based study of national death records. SettingUnited States. Participants/casesAll individuals who died from drug overdose between January 1999 and December 2024. MeasurementsAnnual or monthly (annualized) overdose deaths per 100,000 population. Year and month of occurrence of overdose death...

ObjectiveTo evaluate differences by race/ethnicity in clinical characteristics and outcomes among hospitalized patients with Covid-19 at Massachusetts General Hospital (MGH). MethodsThe MGH Covid-19 Registry includes confirmed SARS-CoV-2-infected patients hospitalized at MGH and is based on manual chart reviews and data extraction from electronic health records (EHRs). We evaluated differences between White/Non-Hispanic and Hispanic patients in demographics, complications and 14-day outcomes am...

IMPORTANCEOver seven million U.S. adults experience "long COVID", or persistent health issues after COVID-19. Multiple guidelines recommend the inclusion of functional status in long COVID diagnostic criteria, but more evidence is needed to guide this recommendation. This study explores the adjusted odds of developing long COVID by pre-infection symptoms and functional status, and the feasibility of estimating functional status using health records data. DESIGNRetrospective cohort study in a mu...