stat investigation
How the 'Swiss model' helped defeat a drug crisis
Djamila Grossman for STAT
At a leading Swiss addiction clinic in Zurich, all patients who need addiction care gain instant access to weeks' worth of medication. They are not required to participate in counseling, or subjected to drug tests, or punished if they relapse and use any kind of illicit substances. American methadone clinics would say that approach leads to disaster. European experts disagree, saying that's the continent's key to success. They have a point in Switzerland, where the opioid death rate is now roughly one-twentieth the U.S. rate.
In a dozen other wealthy, developed nations where methadone is far more accessible than in the U.S., public health outcomes are far better, with lower rates of opioid overdose, infectious disease transmission, and death.
American doctors, lawmakers, and public health officials are beginning to speak out for liberalizing access to methadone as the best tool available to address the crisis. Those who take it are 59% less likely to die of opioid overdose. But American methadone clinics counter that argument, saying that the current restrictions are necessary safety precautions.
That doesn't go over in Europe. "There's just no evidence for it," said Philip Bruggmann, a Swiss doctor and medical director of the Arud Centre for Addiction Medicine, told STAT's Lev Facher. "It really helps people to reintegrate, to stabilize, and I'm not aware of a single case of a person who became opioid-dependent because of this treatment. If you leave it to the black market, people disappear and you can't reach them, and I think the risk is much bigger."
Read more in part 4 of the War on Recovery.
health inequity
Acceptance rates by transplant teams for donated hearts varied by race and gender, study finds
Researcher Khadijah Breathett calls the JAMA findings "really bizarre." While access to donor hearts has improved in recent years, disparities persist in who gets a heart transplant. Breathett, an advanced heart failure transplant cardiologist at Indiana University Health, led a team that discovered both white and Black women were more likely to have an offered heart accepted by their transplant team, but Black men had the longest wait as transplant centers repeatedly rejected offers.
The number of matched offers until an accepted offer was much lower for women, especially white women, and greatest for Black men. For every offer made, the odds were significantly lower for Black individuals than white individuals that one would be accepted. Breathett suspects bias, but in a companion editorial, Paul Heidenreich writes, "I don't think we've proven that African Americans are getting worse care … But we do see concerning disparities." STAT's Deborah Balthazar has more.
reproductive health
Medical abortions rose sharply post-Dobbs
The number of abortions using medications soared after the Supreme Court overturned Roe v. Wade, a new JAMA study reported yesterday, findings that come as arguments begin today in the high court on a challenge to the abortion drug mifepristone. Almost 28,000 doses of the drugs were dispensed in the six months after the Dobbs decision, the study determined, more than four times the average monthly number before Roe was overturned.
The study identified 15 sources outside traditional medical care that distributed abortion pills. Some arrived from clinics overseas, others from "companion networks" in Mexico, as STAT's Olivia Goldhill has reported. "Self-managed medication abortion will likely remain a significant contributor to abortion access in the post-Roe U.S.," the authors write. "Clinicians will need to be prepared to encounter patients who may be considering self-managed medication abortion or who need or want to connect with the formal health care setting for postabortion care."
No comments