Background: Primary care providers are at the center of the opioid epidemic. Whether nurse practitioners (NPs) have different opioid-prescribing outcomes from physicians is not known. Objective: To examine opioid-prescribing outcomes of Medicare beneficiaries receiving care from NPs and physicians in primary care. Research Design: We used Medicare data from 2009 to 2013 and a propensity score–weighted analysis. Subjects: Beneficiaries residing in states in which NPs are able to prescribe controlled substances without physician oversight and who did not have a cancer diagnosis, hospice care, or end-stage renal disease. Measures: First, we measured whether beneficiaries received any opioid prescription. Second, for beneficiaries who received opioids, we measured acute (<90 d supply) and chronic (≥90 d supply) use at baseline (2009–2010) and follow-up (2012–2013). Third, we measured potential misuse of opioid prescribing using a daily morphine milligram equivalent dose of >100 mg, overlapping prescriptions of opioids >7 days, and overlapping prescriptions of opioids with benzodiazepines >7 days. Results: Beneficiaries managed by NPs were less likely to receive an opioid [odds ratio (OR), 0.87; P<0.001], were less likely to be acute users at baseline (OR, 0.84; P<0.001), and were more likely to receive a high daily opioid dose of morphine milligram equivalent >100 mg compared with physician-managed beneficiaries (OR, 1.11; P=0.048). Conclusions: Findings suggest educational programs and clinical guidelines may require approaches tailored to different providers. Future research should examine the contributing factors of these patterns to ensure high-quality pain management and guide policy makers on NP-controlled substance-prescribing regulations.

Over 1.5 million new jobs need to be filled by 2026 for medical assistants, nursing aides, and home care aides, many of which will work in the long-term services and supports (LTSS) sector. Using 16 years of data from the American Time Use Survey, we examined the financial vulnerability of high-skill and low-skill LTSS workers in comparison with other health care workers, while providing insight into their well-being by measuring time spent on work and nonwork activities. We found that, regardless of skill status, working in LTSS was associated with lower wages and an increased likelihood of experiencing poverty compared with other health care workers. Results from time diary data indicated that the LTSS workforce spent a greater share of their time working and commuting to work. Low-skill LTSS workers were hardest hit, spending more time on paid and unpaid activities, such as household and child care responsibilities.

Background: Dentists contribute to the prevailing opioid epidemic in the United States. Among the Medicaid population, little is known about opioid prescribing by dentists. Methods: We performed a retrospective cohort study of Washington State Medicaid beneficiaries with dental claims in 2014 and 2015. The primary outcome was the proportion of dental visits associated with an opioid prescription. Visits were categorized as "invasive" or "non-invasive" using procedure codes, and each beneficiary was categorized as "low" or "high-risk" using their prescription history from the Prescription Drug Monitoring Program. Results: 126,660 (10.3%) of all dental visits among the Washington State Medicaid population were associated with opioid prescriptions, most of which were invasive (66.9%). However, noninvasive dental visits, and visits for beneficiaries with a history of prior high risk prescription use, were associated with significantly higher mean days' supply and mean quantity of opioids prescribed. The multivariate logistic regression showed that the probability of having an opioidassociated visit increased by 35.6 percentage points (pp) when the procedures were invasive, or 11.1pp, when the beneficiary had a history of prior high risk prescription use.

Thirty-three U.S. states and the District of Columbia (DC) have legalized the use of marijuana for medicinal purposes and 10 states and DC have legalized marijuana for adult recreational use. This mirrors an international trend toward relaxing restrictions on marijuana. This article analyzes patterns in marijuana laws across U.S. states to shed light on the social and political forces behind the liberalization of marijuana policy following a long era of conservatism. Data on U.S. state-level demographics, economic conditions, and cultural and political characteristics are analyzed, as well as establishment of and levels of support for other drug and social policies, to determine whether there are patterns between states that have liberalized marijuana policy versus those that have not. Laws decriminalizing marijuana possession, as well as those authorizing its sale for medical and recreational use, follow the same pattern of diffusion. The analysis points to underlying patterns of demographic, cultural, economic, and political variation linked to marijuana policy liberalization in the U.S. context, which deserve further examination internationally.