Offering buprenorphine medication to people with opioid use disorder in jail may reduce rearrest and reconviction

A study conducted in two rural Massachusetts jails found that people with opioid use disorder who were incarcerated and received a medication approved to treat opioid use disorder, known as buprenorphine, were less likely to face rearrest and reconviction after release than those who did not receive the medication.

After adjusting the data to account for baseline characteristics such as prior history with the criminal justice system, the study revealed a 32% reduction in rates of probation violations, reincarcerations, or court charges when the facility offered buprenorphine to people in jail compared to when it did not. The findings were published in Drug and Alcohol Dependence.

The study was conducted by the Justice Community Opioid Innovation Network (JCOIN), a program to increase high-quality care for people with opioid misuse and opioid use disorder in justice settings and funded by the National Institute on Drug Abuse (NIDA), part of the National Institutes of Health, through the Helping to End Addiction Long-term Initiative, or NIH HEAL Initiative.

“Studies like this provide much-needed evidence and momentum for jails and prisons to better enable the treatment, education, and support systems that individuals with an opioid use disorder need to help them recover and prevent reincarceration,” said Nora D. Volkow, M.D., NIDA Director. “Not offering treatment to people with opioid use disorder in jails and prisons can have devastating consequences, including a return to use and heighted risk of overdose and death after release.”

A growing body of evidence suggests that medications used to treat opioid use disorder, including buprenorphine, methadone, and naltrexone, hold great potential to improve outcomes among individuals after they’re released. However, offering these evidence-based treatments to people with opioid use disorder who pass through the justice system is not currently standard-of-care in U.S. jails and prisons, and most jails that do offer them are in large urban centers.

While previous studies have investigated the impact of buprenorphine provision on overdose rates, risk for infectious disease, and other health effects related to opioid use among people who are incarcerated, this study is one of the first to evaluate the impact specifically on recidivism, defined as additional probation violations, reincarcerations, or court charges. The researchers recognized an opportunity to assess this research gap when the Franklin County Sheriff’s Office and the Hampshire County House of Corrections, jails in two neighboring rural counties in Massachusetts, both began to offer buprenorphine to adults in jail, but at different times. Franklin County was one of the first rural jails in the nation to offer buprenorphine, in addition to naltrexone, beginning in February 2016. Hampshire County began providing buprenorphine in May 2019.  

“There was sort of a ‘natural experiment’ where two rural county jails located within 23 miles of each other had very similar populations and different approaches to the same problem,” said study author Elizabeth Evans, Ph.D., of the University of Massachusetts-Amherst. “Most people convicted of crimes carry out short-term sentences in jail, not prisons, so it was important for us to study our research question in jails.”

The researchers observed the outcomes of 469 adults, 197 individuals in Franklin County and 272 in Hampshire County, who were incarcerated and had opioid use disorder, and who exited one of the two participating jails between Jan. 1, 2015 and April 30, 2019. During this time, Franklin County jail began offering buprenorphine while the Hampshire County facility did not. Most observed individuals were male, white, and around 34 to 35 years old.

Using statistical models to analyze data from each jail’s electronic booking system, the researchers found that 48% of individuals from the Franklin County jail recidivated, compared to 63% of individuals in Hampshire County. As well, 36% of the people who were incarcerated in Franklin County faced new criminal charges in court, compared to 47% of people in Hampshire County. The rate of re-incarceration in the Franklin County group was 21%, compared to 39% in the Hampshire County group.

Additional analysis showed that decreases in charges related to property crimes appeared to have fueled the 32% reduction in overall recidivism.

The Massachusetts JCOIN project, led by Dr. Evans and senior author Peter Friedmann, M.D., of Baystate Health, is performing further research on medications for opioid use disorder in both urban and rural jails across more diverse populations, including women and people of color. The investigators are examining the comparative effectiveness of the U.S. Food and Drug Administration-approved medications for opioid use disorder in jail populations, and the challenges jails face in implementing them.

“A lot of data already show that offering medications for opioid use disorder to people in jail can prevent overdoses, withdrawal, and other adverse health outcomes after the individual is released,” said Dr. Friedmann. “Though this study was done with a small sample, the results show convincingly that on top of these positive health effects, providing these medications in jail can break the repressive cycle of arrest, reconviction, and reincarceration that occurs in the absence of adequate help and resources. That’s huge.”

Higher olive oil consumption linked with lower risk of premature death

People who consume higher amounts of olive oil may lower their risk of premature death overall and from specific causes including cardiovascular disease, cancer, and neurodegenerative disease, compared to people who never or almost never consume olive oil, according to a new study led by researchers from Harvard T.H. Chan School of Public Health.

Bottle pouring virgin olive oil in a bowl close up

The researchers also found that people who consumed olive oil instead of animal fat had a lower risk of total and cause-specific mortality.

The study was published online January 10, 2022 in the Journal of the American College of Cardiology.

This is the first long-term observational study on olive oil consumption and mortality in the U.S. Most previous research on olive oil and health has focused on populations from Europe and the Mediterranean, where olive oil consumption is higher.

“Olive oil consumption has been linked to lower cardiovascular disease risk, but its association with premature death was unclear,” said Marta Guasch-Ferré, a senior research scientist in the Department of Nutrition at Harvard Chan School. “Our findings confirm current dietary recommendations to replace animal fats with plant oils for the prevention of chronic diseases and premature death.”

The researchers used health data collected between 1990 and 2018 for 60,582 women participating in the Nurses’ Health Study and 31,801 men in the Health Professionals Follow-up Study. All participants were free of cardiovascular disease or cancer at the beginning of the study and completed dietary questionnaires every four years. During the study period, 36,856 people died.

Participants were asked how often they used olive oil in salad dressings, added to food or bread, or in baking or frying. According to the findings, people in the highest category of olive oil consumption (more than seven grams per day) had 19% lower risk of total and cardiovascular disease mortality, 17% lower risk of cancer mortality, 29% lower risk of neurodegenerative mortality, and 18% lower risk of respiratory mortality, compared with those who never or rarely consumed olive oil. Compared to margarine, butter, mayonnaise, or dairy fat, the use of olive oil was associated with lower risk of total and cause-specific mortality, although no significant risk reduction was observed when use of olive oil was compared to use of other vegetable oils.

“Clinicians should be counseling patients to replace certain fats, such as margarine and butter, with olive oil to improve their health,” Guasch-Ferré said. “Our study helps make specific recommendations that will be easy for patients to understand and hopefully implement into their diets.”

Global growth to slow through 2023 due to continued COVID-19 flare-ups – New Global Economic Prospects report

After rebounding to an estimated 5.5 percent in 2021, global growth is expected to decelerate markedly to 4.1 percent in 2022, reflecting continued COVID-19 flare-ups, diminished fiscal support, and lingering supply bottlenecks, according to a New Global Economic Prospects report.

The COVID-19 upsurge comes as the vaccine supply crunch persists.. Photo credit: United Nations

In contrast to that in advanced economies, output in emerging market and developing economies (EMDEs) will remain substantially below the pre-pandemic trend over the forecast horizon.

The global outlook is clouded by various downside risks, including renewed COVID-19 outbreaks due to Omicron or new virus variants, the possibility of de-anchored inflation expectations, and financial stress in a context of record-high debt levels.

The report states that if some countries eventually require debt restructuring, this will be more difficult to achieve than in the past.

Climate change may increase commodity price volatility, creating challenges for the almost two-thirds of EMDEs that rely heavily on commodity exports and highlighting the need for asset diversification. Social tensions may heighten as a result of the increase in between-country and within-country inequality caused by the pandemic. Given limited policy space in EMDEs to support activity if needed, these downside risks increase the possibility of a hard landing.

These challenges underscore the importance of strengthened global cooperation to foster rapid and equitable vaccine distribution, proactive measures to enhance debt sustainability in the poorest countries, redoubled efforts to tackle climate change and within-country inequality, and an emphasis on growth-enhancing policy interventions to promote green, resilient, and inclusive development and on reforms that broaden economic activity to decouple from global commodity markets.

Climate change may increase commodity price volatility

The near-term outlook for global growth is somewhat weaker, and for global inflation notably higher, than previously envisioned, owing to pandemic resurgence, higher food and energy prices, and more pernicious supply disruptions. Global growth is projected to soften further to 3.2 percent in 2023, as pent-up demand wanes and supportive macroeconomic policies continue to be unwound.

However, the report further noted that although output and investment in advanced economies are projected to return to pre-pandemic trends next year, in emerging market and developing economies (EMDEs)— particularly in small states and fragile and conflict -afflicted countries—they will remain markedly below, owing to lower vaccination rates, tighter fiscal and monetary policies, and more persistent scarring from the pandemic.

Africa Calls for Urgent New Public Health Order

The first international Conference on Public Health in Africa (CPHIA 2021), hosted by the African Union (AU) and Africa Centres for Disease Control and Prevention (Africa CDC) in December concluded its main programme following three days of sessions focused on the need to address long-standing health challenges on the continent, including vaccine inequity and weak health systems.

Over 140 African policymakers, scientists, public health experts, data experts, and civil society representatives presented the latest learnings and research from the COVID-19 pandemic, as well as the actions needed to better guard against current and future health crises.

During the opening ceremony, speakers reflected on the impact of COVID-19 in Africa over the past two years and lessons learnt.
“The inaugural Conference on Public Health in Africa is happening at an important time in history,” said Chairperson of the AU Commission H.E. Moussa Faki Mahamat. “The African continent has not been spared the devastating effects of COVID-19, pushing our health systems to the limits. But we have great hopes for the future, and a historic opportunity to build a New Public Health Order that can effectively guard against future health crises. This conference is the first step in making this a reality.

”The AU’s New Public Health Order calls for continental collaboration to bolster African manufacturing capacity for vaccines, diagnostics and therapeutics; strengthen public health institutions for people-centred care; expand the public health workforce; establish respectful, action-oriented partnerships; and engage with the private sector. These pillars are part of the continent’s approach to meeting the aspirations of the Agenda 2063 – the Africa We Want.

Photo credit: United Nations

“There is a need for renewed commitments by governments and national parliaments to increase domestic financing for health in Africa. This has been a priority of the African Union for several years, but progress has not been fast enough. We cannot continue to rely on external funding for something so important to our future,” said H.E. Paul Kagame, President of Rwanda and AU Champion for Domestic Health Financing. “We need to invest much more in national health systems. The ability to implement critical health programmes, including regular mass vaccination campaigns depends on the quality of national health services and the trust the public have in them.”

“Maybe the Ebola outbreak of 2014 to 2016 was a call to action that something bigger was to come. And maybe COVID-19 is the signal that something even bigger will come. So, we must be prepared and take our health security destiny into our own hands,” said Dr. John Nkengasong, Director of the Africa CDC. “It
means we have to fight the next pandemic in a way that is unparalleled to the way we are fighting this pandemic, and I am very convinced that we will do that given the mobilization, commitment and investments that are currently going on.”

 Prof. Salim Abdool Karim, Director of the Center for the AIDS Program of Research in South Africa (CAPRISA), who is among those leading research into the Omicron variant. Explaining the variant’s trajectory in South Africa, emphasized the need to continue trusting and implementing strong public health interventions.

“There is no need to panic. We’ve dealt with variants before, including those with immune escape. Closing borders has almost no benefit. Public health systems work, public interventions like masks and social distancing work. Let’s use them,” said Prof. Karim.

The Democratic Republic of Congo declares over the thirteenth Ebola Virus Disease Outbreak

The Democratic Republic of Congo (DRC) has reported zero case of Ebola since the country declared the end of the 13th Ebola virus disease (EVD) outbreak on the 16th December 2021.

This is the second EVD outbreak reported this year from the DRC. Results from genomic sequencing show that this outbreak is linked to the 2018 EVD outbreak reported from the same province.

The outbreak was declared on 08 October 2021 in Beni Health Zone in North Kivu Province. In this outbreak, a total of 11 cases (8 confirmed, 3 probable), nine deaths (6, 3) and two recoveries of EVD were reported. These cases were distributed across three health areas: Butsili (9 cases, 7 deaths, 2 recoveries), Bundji (1, 1, 0) and Kanzulinzuli (1, 1, 0). The cumulative case fatality ratio is 82%. The last confirmed case was reported on 30 October 2021. The outbreak was successfully contained within the Beni Health Zone and no further cases were reported in other provinces.

“This is another example from the DRC showing a good example of applying the knowledge and expertise gained from previous recurrent outbreaks to quickly fight and bring the 13th outbreak to an end,” said Dr John Nkengasong, Director of Africa Centres for Disease Control and Prevention (Africa CDC).

The African Union Commission, through the Africa CDC, had deployed frontline workers and experts from the headquarter to support response to the 13th outbreak and donated medical and non-medical supplies including infection prevention and control kits, and laboratory consumables. The Africa CDC will continue to work with the Government of DRC and other partners to better coordinate our efforts in strengthening health systems in the country and across Africa

New Study Emphasizes Critical Need for Diversity of Research Participants in Genetic Studies

Studies of whites dominate the research literature to date despite being one of the smallest populations worldwide. 

A new paper in Nature presents evidence that the field of human genetics must improve the diversity of research participants to avoid worsening existing health inequities among different racial and ethnic groups, particularly where heart disease is concerned.

Blood cholesterol levels (also called lipid levels) are both highly genetic and a highly treatable health trait, and serve as a primary risk factor for heart disease, the leading cause of death worldwide. However, most previous genome-wide association studies, a study design used to detect associations between genetic variants and common diseases or traits in a population, have been conducted in European ancestry populations. Therefore, they may have missed genetic variants contributing to lipid level variation in other ancestry groups. 

The Nature article is a large collaboration with hundreds of coauthors from over 200 studies in 44 countries. It takes a look at the blood cholesterol levels of around 350,000 participants with Hispanic, African, East Asian, or South Asian ancestry, in addition to 1.3 million participants with European ancestry.

The paper’s key findings include:

• Most genetic variations that influence lipid levels are observed across all populations, but at least some variants are uniquely observed in one population, particularly among individuals with African ancestry or Hispanics.
• The ability to pinpoint the genetic variants most likely responsible for biological effects and to predict lifelong LDL cholesterol (“the bad cholesterol”) levels using genetic risk scores improves significantly when the initial genetic study includes diverse ancestries.
• There is a need not only for future larger genetic studies of lipid levels but also for studies that prioritize the enrollment of individuals from diverse ancestries to improve genetic studies of health traits and diseases, such as cardiovascular disease.

“A sensible and equitable approach is to ensure diverse ancestries are represented in genetic studies whenever possible. Diversity helps to determine the degree to which findings can be generalized to other health traits and diseases,” says Yan Sun, PhD, associate professor of epidemiology, who is co-senior author on the paper.

Article published courtesy of Emory University

NASA-supported Study Confirms Importance of Southern Ocean in Absorbing Carbon Dioxide

Observations from research aircraft show that the Southern Ocean absorbs much more carbon from the atmosphere than it releases, confirming it is a very strong carbon sink and an important buffer for some of the effects of human-caused greenhouse gas emissions, according to a new NASA-supported study.

Recent research had raised uncertainty about just how much atmospheric carbon dioxide (CO₂) these icy waters absorb. Those studies relied on measurements of ocean acidity – which increases when ocean water absorbs CO₂ – taken by instruments that float in the ocean.

The new study, published in Science, used aircraft observations of CO₂ to show that the Southern Ocean is a stronger carbon sink than previously thought, playing a significant role in lessening some of the impacts of greenhouse gases. Aircraft observations were collected over nearly a decade from 2009 to 2018 during three field experiments, including from NASA’s Atmospheric Tomography Mission (ATom) in 2016.

“Airborne measurements show a drawdown of carbon dioxide in the lower atmosphere over the Southern Ocean surface in summer, indicating carbon uptake by the ocean,” explained Matthew Long, lead author and a scientist at the National Center for Atmospheric Research (NCAR) in Boulder, Colorado.

They found that the Southern Ocean absorbs significantly more CO₂ in the Southern Hemisphere summer than it releases in the winter, making it a strong carbon sink. Data from the airborne campaigns also showed a larger amount of carbon absorbed by the Southern Ocean and smaller amount released than previous estimates using ocean acidity data. The findings highlight the importance of aircraft-based observations to understand carbon cycling.

The research was funded by the National Science Foundation, NASA and NOAA.