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Op-Ed: Trust and Tracing | MedPage Today

The fight against COVID-19 requires regaining and maintaining immigrants’ trust in our public health system. The Trump administration’s public charge rule, which empowers the U.S. government to deny green cards to immigrants who receive welfare benefits, could prove to be a public health problem by reducing immigrants’ willingness to engage in contract tracing and testing and trust leaders.

With 70% of immigrants in the labor force serving as essential workers, whether it be as healthcare providers or meatpacking plant workers, immigrants are at greater risk of being exposed to COVID-19. In fact, reports across the country show that migrant farmworker communities face not only higher COVID-19 exposure, but also more damaging effects from the current West Coast wildfires.

This news is concerning as immigrants are more likely to lack health insurance, with 23% of immigrants with legal status and 45% of undocumented immigrants lacking insurance, compared with 8% of citizens.

If this trend wasn’t bad enough, reports have shown that Trump’s public charge rule has made immigrants afraid to seek healthcare. The Kaiser Family Foundation has found that immigrants are disenrolling in healthcare benefit programs like Medicaid. A report from the Chicano Federation shows that this is not a theoretical issue as places like San Diego county struggle to convince community members to share personal information with contact tracers: it is an urgent one, with potentially catastrophic public health implications.

This lack of confidence is exactly why improving immigrants’ trust in the U.S. public health system is an issue of public concern. If immigrants distrust testing and contact tracing programs, there is an increased likelihood that COVID-19 will spread undetected in all communities — hampering states’ abilities to re-open their economies and contain the pandemic.

As individuals in the medical field and the children of immigrants, ensuring that immigrants trust COVID-19 testing and contact tracing programs is medically necessary and deeply personal. This understanding is why we have outlined some immediate policy steps to rebuild immigrants’ trust in public health systems during the COVID-19 pandemic.

  • First, the public charge rule should be rescinded. This would ensure that immigrants are not afraid to use the many community clinics that serve people regardless of citizenship status or ability to pay. These clinics are often key resources for necessary testing that must take place. In addition, immigrants wouldn’t withdraw their children from important insurance programs, like the Children’s Health Insurance Program, that provide access to care for low-income children. Furthermore, removing green card penalties for obtaining necessary food and housing assistance programs will increase immigrants’ willingness to access testing and contact tracing programs
  • Second, the federal government should make good on its promise to cover testing fees for all citizens and residents. This is very important as those who lack insurance face exorbitant testing costs. Covering the costs of testing fees will make it more likely that immigrant communities are able to access tests
  • Third, on the state level, public health departments should work with community organizations to share information and emphasize the

Dax Shepard’s Opioid Relapse | MedPage Today

Actor/comedian Dax Shepard has always been open about his past struggles with addiction and how he has been sober for the past 16 years. However, it was still surprising when, on the September 25th episode of his podcast Armchair Expert, Shepard revealed that he relapsed and has again been taking opioids.

About 6 months ago, Shepard broke his right hand, which required the temporary placement of a pin. Then in August, the avid motorcycle rider went over the handlebars of a bike during a race, breaking four ribs and shattering his shoulder. He again underwent surgery. Although he was prescribed hydrocodone/acetaminophen (Vicodin) for the pain, monitored by his wife, actress Kristen Bell, Dax began to “supplement” these pills with others that he purchased on his own.

As he told his podcast co-host, Monica Padman: “For the last 8 weeks maybe, I don’t really know … I’m on them all day … And I’m allowed to be on them at some dosage, because I have a prescription, and then I’m also augmenting that. And then all the prescriptions run out, and I’m now just taking 30 mil oxys that I’ve bought whenever I decide I can do [it].”

As he was still able to fulfill his daily responsibilities, including his twice-weekly podcast, he thought everything was under control. But then he started lying: “And I hate it, and I’m lying to other people. And I know I have to quit. But my tolerance is going up so quickly that I’m now in a situation where I’m taking, you know, eight 30s a day, and I know that’s an amount that’s going to result in a pretty bad withdrawal. And I start getting really scared, and I’m starting to feel really lonely. And I just have this enormous secret.”

Monica eventually called him out, and he came clean to her and Kristen. He immediately gave his pills to his wife and Monica to titrate down, began to go to AA meetings, and underwent withdrawal symptoms: “I’m sweating bullets; I’m jerky; my back kills. It’s terrible.”

Shepard went on to apologize to his friends, family, and his fans for deceiving them. He felt it was his responsibility to come forward and be honest about his struggles in the hope that others can also come forward and get the help they need.

Prescription Opioids

Prescription opioids can be used to treat moderate-to-severe pain and are often prescribed following surgery or injury, or for health conditions such as cancer.

In recent years, there has been a dramatic increase in the acceptance and use of prescription opioids for the treatment of chronic, non-cancer pain, such as back pain or osteoarthritis, despite serious risks and the lack of evidence about their long-term effectiveness.

According to the CDC:

  • More than 168 million opioid prescriptions were dispensed to American patients in 2018
  • There is a wide variation of opioid prescription rates across states; healthcare providers in the highest prescribing state, Alabama, wrote almost three times as many of these