"In total, there were 10,514 injections and 33 opioid-involved overdoses over 5 years, all of which were reversed by naloxone administered by trained staff (Table 1). No person who overdosed was transferred to an outside medical institution, and there were no deaths. The number of overdoses increased over the years of operation, due partially to the number of injections increasing over the same period of time (Fig. S1 in the Supplementary Appendix).
"Once incarcerated, children are at risk of physical and psychological abuse, sexual assault, suicide and other harms, including inadequate educational instruction. The use of solitary confinement further deprives them of social interaction, mental stimulation and key services during a critical time of adolescent brain development. Risks are heightened for children in the adult criminal justice system, which is focused on punishment rather than rehabilitation and treatment.
"Boys, youth with disabilities and LGBTQ youth also come into disproportionate contact with juvenile and adult criminal justice systems.
" In 2017, the residential placement rate for boys was more than five times that for girls. Eighty-five percent of children in residential placement were male.10
" Although 62 percent of children arrested in the U.S. were white, children of color were nearly two times more likely to be arrested than white children.5 Black children were two and a half times more likely.6
" In 2017, the residential placement rate for children of color was more than two times that for white children nationwide and more than four times that for white children in 18 states and the District of Columbia. Black children were committed or detained at nearly five times the rate of white children.7
"First, we confirmed that the rate of diagnosed OUD has increased steadily among commercially insured adults, and we documented how the age distribution of OUD has changed. In 2008 diagnosed OUD among the youngest age group (ages 18–24) was more than double that among the oldest group (ages 55–64). However, in 2017 diagnosis rates exhibited a hump-shaped pattern in age, with the highest rate (4.75 per 1,000 enrollees) among the middle-aged (people ages 35–44) and the greatest increase among the near-elderly (ages 55–64).
"County and city jails in the United States held 738,400 inmates at midyear 2018 (table 1), a decline of 6% from 785,500 inmates held in 2008. The midyear population remained relatively stable from 2011 to 2018. At midyear 2018, about one-third of jail inmates (248,500) were sentenced or awaiting sentencing on a conviction, while about two-thirds (490,000) were awaiting court action on a current charge or were held for other reasons.
"During 2018, drug overdoses resulted in 67,367 deaths in the United States, a 4.1% decrease from 2017. Among these drug overdose deaths, 46,802 (69.5%) involved an opioid. From 2017 to 2018, opioid-involved death rates decreased 2.0%, from 14.9 per 100,000 population to 14.6 (Table 1); decreases occurred among females; persons aged 15–34 years and 45–54 years; non-Hispanic whites; and in small metro, micropolitan, and noncore areas; and in the Midwest and South regions.
"In 2016 only 13.8 percent of substance use treatment programs accepted Medicare and offered an FDA-approved medication for opioid use disorder treatment (exhibit 1). While the percentage of programs that offered such treatment was low across all insurance types (24.8 percent among programs that accepted Medicaid and 28.6 percent among programs that accepted private insurance), access for Medicare beneficiaries was nearly twice as limited.
"● In 2018, there were 67,367 drug overdose deaths in the United States, a 4.1% decline from 2017 (70,237 deaths).
"● The age-adjusted rate of drug overdose deaths in 2018 (20.7 per 100,000) was 4.6% lower than in 2017 (21.7).
"● For 14 states and the District of Columbia, the drug overdose death rate was lower in 2018 than in 2017.
"● The rate of drug overdose deaths involving synthetic opioids other than methadone (drugs such as fentanyl, fentanyl analogs, and tramadol) increased by 10%, from 9.0 in 2017 to 9.9 in 2018.
"Even well-intentioned policies have exacerbated the link between opioid use and infectious disease. For instance, prescription drug monitoring programs and other measures to limit access to prescription opioids triggered a transition to heroin and, eventually, injection use among people who had become dependent on prescription pain relievers. At the same time, primary care clinics have not adequately screened, treated, and retained patients in treatment for substance use disorders.