Harold Pollack

• University of Chicago

Importance Many of the approximately 2 million people being held in US correctional facilities are experiencing an opioid use disorder (OUD). Providing medications for OUD (MOUD) to this population is, therefore, essential to curb the opioid crisis. Objective To examine the types of MOUD jails are making available, factors associated with availabi...

There is much focus in the field of HIV prevention research on understanding the impact of social determinants of health (e.g., housing, employment, incarceration) on HIV transmission and developing interventions to address underlying structural drivers of HIV risk. However, such interventions are resource-intensive and logistically challenging, an...

Importance Opioid-related overdose accounts for almost 80 000 deaths annually across the US. People who use drugs leaving jails are at particularly high risk for opioid-related overdose and may benefit from take-home naloxone (THN) distribution. Objective To estimate the population impact of THN distribution at jail release to reverse opioid-relat...

Aims To understand how the US public defines recovery from opioid misuse and the recovery‐related resources it views as most helpful, and to compare differences by opioid misuse history and demographic characteristics. Design Observational study of data from the nationally representative AmeriSpeak® Panel survey administered in October/November 20...

Importance In 2023, more than 80 000 individuals died from an overdose involving opioids. With almost two-thirds of the US jail population experiencing a substance use disorder, jails present a key opportunity for providing lifesaving treatments, such as medications for opioid use disorder (MOUD). Objectives To examine the prevalence of MOUD in US...

This Viewpoint describes existing public health and social service systems for persons with intellectual and developmental disabilities as they transition to adult care, barriers and opportunities faced in service access, and potential actions to narrow these gaps and enhance equity.

BACKGROUND The United States overdose epidemic is an escalating public health emergency, accounting for over 100,000 deaths annually. Despite the availability of medications for opioid use disorder, provider-level barriers exacerbate the treatment gap in clinical care settings. Assessing the prevalence and intensity of provider stigma, defined as t...

Background The US overdose epidemic is an escalating public health emergency, accounting for over 100,000 deaths annually. Despite the availability of medications for opioid use disorders, provider-level barriers, such as negative attitudes, exacerbate the treatment gap in clinical care settings. Assessing the prevalence and intensity of provider s...

This Viewpoint discusses 3 types of systemic health inequity experienced by individuals with intellectual and developmental disabilities—stigma, exclusion, and devaluation of worth; underrepresentation in population epidemiology and research; and inadequate access to care and social services—and suggests potential approaches to ameliorating inequit...

Importance Medicare beneficiaries with disabilities aged 18 to 64 years face barriers accessing ambulatory care. Past studies comparing Medicare Advantage (MA) with traditional Medicare (TM) have not assessed how well these programs meet the needs of beneficiaries with disabilities. Objective To compare differences in enrollment rates, ambulatory...

Establishing care with primary care and specialist clinicians is critical for Medicare beneficiaries with complex care needs. However, beneficiaries with disabilities may struggle to access ambulatory care. This study uses the 2015-17 national Medicare Current Beneficiary Survey linked to claims and administrative data to explore these questions. M...

Just one in ten nonfatal shootings in Chicago lead to an arrest. Unlike in fatal cases, gunshot victims who survive can often provide information of use in the police investigation. Nonetheless, nonfatal shooting cases in Chicago and elsewhere have much lower arrest rates than fatal cases, in part because most victims do not cooperate. We use data...

Importance: The US opioid epidemic is complex and dynamic, yet relatively little is known regarding its likely future impact and the potential mitigating impact of interventions to address it. Objective: To estimate the future burden of the opioid epidemic and the potential of interventions to address the burden. Design, setting, and participan...

Background: Calls for more patient-centered care are growing in the substance use disorder (SUD) treatment field. However, evidence is sparse regarding whether patient-centered care improves access to, or utilization of, effective treatment services. Methods: Using nationally representative survey data from SUD treatment clinics in the United St...

This article describes evidence-based strategies designed to reduce the prevalence of police encounters with people in behavioral crisis (PBCs) and to make such encounters less dangerous for all parties when they do occur. Some of these strategies are implemented by law enforcement, including gun violence restraining orders and the training of offi...

Context: In contrast to the Affordable Care Act, some have suggested the opioid epidemic represents an area of bipartisanship. This raises an important question: to what extent are Democrat-led and Republican-led states different or similar in their policy responses to the opioid epidemic? Methods: Three main methodological approaches were used to...

Objective: Substance use disorder treatment professionals are paying increased attention to implementing patient-centered care. Understanding environmental and organizational factors associated with clinicians' efforts to engage patients in clinical decision-making processes is essential for bringing patient-centered care to the addictions field....

Guns that are used in crime and recovered by the police typically have changed hands often since first retail sale and are quite old. While there is an extensive literature on “time to crime” for guns, defined as the elapsed time from first retail sale to known use in a crime, there is little information available on the duration of the “last link”...

Objectives. To assess states' provision of technical assistance and allocation of block grants for treatment, prevention, and outreach after the expansion of health insurance coverage for addiction treatment in the United States under the Affordable Care Act (ACA). Methods. We used 2 waves of survey data collected from Single State Agencies in 2014...

Objective Dental clinics offer an untapped health care setting to expand access to screening and early identification of cardiovascular disease (CVD) risk. This study examined the correlates of dentists’ willingness to provide CVD screening in the dental care setting. Methods Private practice and public health general dentists in the U.S. particip...

Objectives: To examine how utilization restrictions on state Medicaid benefits for buprenorphine are related to addiction treatment programs' decision to offer the drug. Methods: We used data from 2 waves of the National Drug Abuse Treatment System Survey conducted in 2014 and 2017 in the United States to assess the relationship of utilization r...

Hagit Bonny-Noach notes the challenging history of illicit substance use among Israeli backpackers. Few Israeli practices are more normative than the backpacking-trip as a rite of passage. Unsurprisingly, backpacking in far-off locales provides occasion to experiment with the various intoxicating experiences young adult life has to offer. Some such...

The nation's methadone maintenance treatment (MMT) programs play a central role in addressing the current opioid epidemic. Considerable evidence documents the treatment effectiveness of MMT and, in turn, the importance of adequate dosing to MMT's effectiveness. Yet, as recently as 2011, 41% of patients received doses below the level of 80 mg/day. U...

Importance Expanding treatment for opioid addiction has been recognized as an essential component of a comprehensive national response to the opioid epidemic. The Drug Addiction Treatment Act and its amendments attempted to improve access to treatment by involving office-based physicians in the provision of buprenorphine treatment. Objectives To e...

The Affordable Care Act (ACA) established a minimum standard of insurance benefits for addiction treatment and expanded federal parity regulations to selected Medicaid benefit plans, which required state Medicaid programs to make changes to their addiction treatment benefits. We surveyed Medicaid programs in all fifty states and the District of Col...

Objective: To assess the relationship of restrictions on Medicaid benefits for addiction treatment to Medicaid acceptance among addiction treatment programs. Data sources: We collected primary data from the 2013-2014 wave of the National Drug Abuse Treatment System Survey. Study design: We created two measures of benefits restrictiveness. In t...

Background: The dental setting is a potential venue for identifying patients experiencing intimate partner violence (IPV). The study objective was to assess dentists' current practices and attitudes about IPV screening. Methods: A nationally representative survey of US general dentists assessed dentists' use of health history forms that queried...

Background: Established in 2014, state health insurance exchanges have greatly expanded substance use disorder (SUD) treatment coverage in the United States as qualified health plans (QHPs) within the exchanges are required to conform to parity provisions laid out by the Affordable Care Act and the Mental Health Parity and Addiction Equity Act (MH...

Objective: As the United States grapples with an opioid epidemic, expanding access to effective treatment for opioid use disorder is a major public health priority. Identifying effective policy tools that can be used to expand access to care is critically important. This article examines the relationship between state-targeted funding and technica...

The dental setting is a largely untapped venue to identify patients with undiagnosed HIV infection. Yet, uptake of rapid HIV testing within the dental community remains low. This study sought to better understand the experiences of dental professionals who have administered the test and how these experiences might inform efforts to promote greater...

We present the results of three large-scale randomized controlled trials (RCTs) carried out in Chicago, testing interventions to reduce crime and dropout by changing the decision-making of economically disadvantaged youth. We study a program called Becoming a Man (BAM), developed by the non-profit Youth Guidance, in two RCTs implemented in 2009–10...

Background and aims: Buprenorphine is commonly used to treat opioid use disorder; however, non-buprenorphine prescription opioid use among these patients is not well defined. We sought to estimate the prevalence of non-buprenorphine opioid use among incident buprenorphine users and quantify levels of opioid use prior to, during and after the first...

The Affordable Care Act requires state Medicaid programs to cover substance use disorder treatment for their Medicaid expansion population but allows states to decide which individual services are reimbursable. To examine how states have defined substance use disorder benefit packages, we used data from 2013-14 that we collected as part of an ongoi...

Background: To meet their aims of providing comprehensive and coordinated care, patient-centered medical homes (PCMHs) need to coordinate services for individuals with substance use disorders. Yet, the 14,000 addiction treatment (AT) organizations across the United States that provide services for more than 1 million individuals daily are generall...

Fragile X syndrome (FXS) is the most common heritable form of intellectual disability. Adults with FXS vary in their health status and functional capacity and require a range of caregiving activities, including full-time supervision, help with activities of daily living, and coordination of daily activities and services. Through the lens of life co...

Guydish and colleagues document the high prevalence of tobacco use among addiction treatment patients in many countries. Tobacco accounts for widespread premature mortality among individuals with addiction disorders, yet smoking cessation does not receive the attention it deserves in treatment settings.

Over the past fifty years Medicaid has taken divergent paths in financing mental health and addiction treatment. In mental health, Medicaid became the dominant source of funding and had a profound impact on the organization and delivery of services. But it played a much more modest role in addiction treatment. This is poised to change, as the Affor...

The Affordable Care Act (ACA) dramatically expands health insurance for addiction treatment and provides unprecedented opportunities for service growth and delivery model reform. Yet most addiction treatment programs lack the staffing and technological capabilities to respond successfully to ACA-driven system change. In light of these challenges, w...

AimsThe dental setting is a potentially valuable venue for screening for substance misuse. Therefore, we assessed dentists’ inquiry of substance misuse through their patient medical history forms and their agreement with the compatibility of screening as part of the dentists’ professional role.DesignA nationally representative survey of general den...

Gun violence places a lethal toll on public health. This paper focuses on reducing access to firearms by dangerous offenders. The original empirical contribution is to provide new data on the gun transactions that arm offenders in Chicago, with the goal of improving enforcement actions. The data are from an open-ended survey of 99 inmates of Cook C...

In this Article, we seek to help guide law enforcement activities targeting gun acquisition by high-risk people by examining two potentially important sources of crime guns: licensed retail dealers and traffickers. Limited data availability is a key reason more is not currently known about how criminals obtain guns. This Article assembles a unique...

Background: Implementation of the Affordable Care Act (ACA) creates new opportunities for engaging HIV-positive and high-risk negative persons into evidence-based prevention and treatment strategies. Community-based organizations (CBOs) are well positioned to reach individuals whom these interventions might benefit most. Many structural and philoso...

Introduction Dental visits represent an opportunity to identify and help patients quit smoking, yet dental settings remain an untapped venue for treatment of tobacco dependence. The purpose of this analysis was to assess factors that may influence patterns of tobacco-use–related practice among a national sample of dental providers. Methods We surv...

Effective treatment for patients with opioid use problems is as critical as ever given the upsurge in heroin and prescription opioid abuse. Yet, results from prior studies show that the majority of methadone maintenance treatment (MMT) programs in the US have not provided dose levels that meet evidence-based standards. Thus, this paper examines the...

AimsTo review empirical research that seeks to relate marginal increases in enforcement against the supply of illicit drugs to changes in drug prices at the level of the drug supply system being targeted. Method Review of empirical studies. FindingsAlthough the fact of prohibition itself raises prices far above those likely to pertain in legal mark...

Objectives: We explored insurers' perceptions regarding barriers to reimbursement for oral rapid HIV testing and other preventive screenings during dental care. Methods: We conducted semistructured interviews between April and October 2010 with a targeted sample of 13 dental insurance company executives and consultants, whose firms' cumulative m...

Objectives: Using a nationally representative survey, we determined dentists' willingness to provide oral rapid HIV screening in the oral health care setting. Methods: From November 2010 through November 2011, a nationally representative survey of general dentists (sampling frame obtained from American Dental Association Survey Center) examined...

This article examines changes from 2005 to 2011 in the use of an evidence-based clinical innovation, buprenorphine use, among a nationally representative sample of opioid treatment programs and identifies characteristics associated with its adoption. We apply a model of the adoption of clinical innovations that focuses on the work needs and charact...

To identify the extent to which clients in a national sample of opioid treatment programs (OTPs) received HIV testing in 2005 and 2011; to examine relationships between state laws for informed consent and pretest counseling and rates of HIV testing among OTP clients. Data were collected from a nationally representative sample of OTPs in 2005 (n = 1...

Improving the long-term life outcomes of disadvantaged youth remains a top policy priority in the United States, although identifying successful interventions for adolescents – particularly males – has proven challenging. This paper reports results from a large randomized controlled trial of an intervention for disadvantaged male youth grades 7-10...

Drug courts have been widely praised as an important tool for reducing prison and jail populations by diverting drug-involved offenders into treatment rather than incarceration. Yet only a small share of offenders presenting with drug abuse or dependence are processed in drug courts. This study uses inmate self-report surveys from 2002 and 2004 to...

After nearly a century of failed or incomplete legislative efforts, the Patient Protection and Affordable Care Act (PPACA), enacted by Congress in March 2010, establishes the principle that every American is entitled to affordable and effective health insurance coverage regardless of income or health status. Although many aspects of the act have re...

Background: 2006 CDC guidelines recommend widespread HIV screening in a variety of health care settings. Prior research highlights the potential of the dental care setting as a promising venue for the screening of otherwise untested individuals at risk for HIV infection. Insurers' current and future reimbursement policies have been identified as on...

BACKGROUND: One-fifth of approximately 1 million Americans living with HIV are undiagnosed and unaware of their infected status. In 2006, the CDC issued recommendations to incorporate routine HIV screening in all healthcare settings, including dental clinics. Increasing the number of individuals who know their serostatus could decrease HIV incidenc...

Prior research has identified the dental setting as a potentially fruitful arena to detect undiagnosed cases of HIV infection. Insurance reimbursement poses one potential obstacle to the delivery of such services. To explore these issues, semi -structured interviews were conducted with 14 dental insurance company executives and consultants comprisi...

Identification of undiagnosed persons with HIV infection is a public health challenge. 2006 CDC guidelines recommend widespread screening in many health care settings. Prior research highlights dental care settings as promising venues for HIV screening. A nationally representative survey of general dentists was performed to examine barriers and f...

BACKGROUND: Identification of undiagnosed persons with HIV infection is a public health challenge. The 2006 CDC guidelines recommend wide spread screening in a variety of health care settings. Prior research highlights the potential of the dental care setting as a promising venue for HIV screening of otherwise untested individuals. METHODS: We perf...

In their manuscript, Corsaro, Hunt, Kroovand Hipple, and McGarrell (2012, this issue) provide a valuable contribution to the literature regarding focused deterrence with an econometric evaluation of the High Point Drug Market Intervention (DMI). By employing a difference-in-difference Poisson panel regression framework, as well as group-based traje...

Despite increasing discussion about the dental care setting as a logical, potentially fruitful venue for rapid HIV testing, dentists' willingness to take on this task is unclear. Semistructured interviews with 40 private practice dentists revealed their principal concerns regarding offering patients HIV testing were false results, offending patient...

Screening and delivery of evidence-based interventions by dentists is an effective way to reduce tobacco use. However, dental visits remain an underutilized opportunity for the treatment of tobacco dependence. This is, in part, because the current reimbursement structure does not support expansion of dental providers' role in this arena. The purpos...