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Midwestern states have adopted a variety of intervention strategies designed to combat the opioid epidemic and manage the risks associated with injection drug use. These harm reduction efforts include syringe exchange programs; medication-assisted therapy; overdose prevention; public education campaigns; and policies and laws designed to enhance collaboration among advocates, law enforcement and health care professionals.

by Joshua Sharfstein
According to the National Academy of Sciences, the average life expectancy is lower in the United States than in other nations with advanced economies. Within our borders, African-Americans, rural Americans and poor Americans on average die years earlier than others. In fact, for some groups–including poor, white Americans–as a result of suicide, drug addiction and chronic illness, life expectancy is now actually falling. It is no surprise that political leaders across the ideological spectrum increasingly are asking what can be done to protect and promote the health of their communities. In many areas, county and state governments are calling on state and local public health departments to deliver major improvements in health. What does it take to save lives—not one by one through medical treatment, but hundreds of thousands or even millions at a time? This may sound like a crazy question, but it’s the right one to ask. Public health campaigns have in fact saved the lives of millions of people in the United States and around the world from malnutrition, infectious disease, unclean water and air, and other preventable conditions. In the United States, even today, up to half of all premature deaths are preventable.

by Kana Enomoto and Dr. Kimberly A. Johnson
Addiction is a chronic, neurobiological condition with the potential for recovery and relapse. We know that recovery is possible and that treatment works best if it is multi-dimensional, evidence-based, and addresses both the physiological and psychological elements of substance use disorders. When coupled with appropriate psychosocial supports, medication-assisted treatment can provide one of the best paths to long-term recovery. Medication-assisted treatment, also known as MAT, is one of the most powerful tools in the behavioral health toolbox for responding to heroin and opioid use disorders. Methadone, buprenorphine and extended-release injectable naltrexone all reduce opioid use, opioid use disorder-related symptoms, risk of infectious disease and crime, according to The American Society of Addiction Medicine’s 2003 report, Advancing Access to Addiction Medications.

Vermont Gov. Peter Shumlin attracted national attention more than two years ago when he spent his entire state-of-the-state speech describing what he called “a full-blown heroin crisis” in his state. “In every corner of our state, heroin and opiate drug addiction threatens us,” he said. The number of overdose deaths from heroin in Vermont had doubled from the year before. Another indication of trouble in the state, Shumlin said, was the rise in the number of Vermonters in treatment for opiate addictions—up 770 percent since 2000, numbering 4,300 people in 2012. Fast forward to late March 2016, when President Barack Obama appeared in Atlanta before a national summit of almost 2,000 professionals, advocates and people in recovery to discuss prescription opioid abuse and heroin use. He said 28,000 people in the United States died from opioid drug overdoses in 2014.

America’s public state universities were established primarily to serve the residents of their respective states, but recent findings show that state institutions are increasingly appealing to out-of-state students. Opponents of this practice have concerns that certain in-state applicants are being neglected and left behind. An analysis of 100 state universities, including the flagship institution of each state and one additional prominent public university, shows that from 2004 to 2014, 74 saw declines in in-state freshmen as a share of total enrollment.

On June 7, Tennessee Senate Majority Leader Mark Norris, who served as the 2014 CSG national chair, testified before the U.S. Senate Environment and Public Works Subcommittee on Superfund, Waste Management and Regulatory Affairs at a hearing regarding “Oversight of EPA Unfunded Mandates on State, Local, and Tribal Governments.” The hearing was a continuation of the subcommittee’s oversight of the Environmental Protection Agency’s rulemaking process and examined the agency’s compliance with the Unfunded Mandates Reform Act, or UMRA, and the impact of unfunded mandates on state, local and tribal governments. 

When U.S. Secretary of Transportation Anthony Foxx finished his remarks at the recent InfraAmericas conference on public-private partnerships, or P3s, in New York City, Kentucky state Rep. Leslie Combs was first to the microphone for the Q&A. “We just passed P3 legislation in Kentucky,” said Combs, who this spring authored the legislation that allows Kentucky, like 33 other states, Puerto Rico and the District of Columbia, to enter into P3s to build infrastructure projects.

by Katherine Barrett and Richard Greene
The phrase “evidence-based” has become ubiquitous in state government circles. The concept is simple: Decisions, in an evidence-based system, are made based on validated prior experiences and research, rather than just on opinions, anecdotes and ideologies. But, “often that work hasn’t included health,” said Rebecca Morley, director of the Health Impact Project, a collaboration of the Robert Wood Johnson Foundation and the Pew Charitable Trusts. Morley’s efforts, along with others, have been to encourage and assist states and localities in developing so-called health impact assessments, or HIAs, which are “a very specific tool for bringing health issues to decision making,” she explained. HIAs use a variety of procedures, methods and tools to evaluate the potential health effects of a policy, program or project, according to the World Health Organization.

Twenty-five states and the District of Columbia currently allow marijuana use either for medicinal and/or recreational purposes. As marijuana use becomes more prevalent in states and legalization gains more popular support, states are addressing the myriad issues arising out of marijuana legalization, such as banking, environmental impacts and driving. In light of a new report by the AAA Foundation for Traffic Safety that found drivers who recently used marijuana were involved in twice as many fatal car accidents in Washington after the state legalized cannabis, states are wrestling with the question: How high is too high to drive?

Members of The Council of State Governments’ Overseas Voting Initiative Technology Working Group discussed technology that could help U.S. military and overseas citizens in the voting process during a recent CSG eCademy webcast.

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