Jacob James Rich | PhD Candidate | Case Western Reserve University

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Current Research:

Opioid Prescribing Mediating State Policy Intervention Effects on Drug Overdose Mortality

The Centers for Disease Control and Prevention reported 70 630 drug overdose deaths for 2019 in the United States, 70.5% of which were opioid-related. Preliminary estimates now warn that drug overdose deaths likely surpassed 86 000 during 2020. Despite a 57.4% decrease in opioid prescribing since a peak in 2012, the opioid death rate has increased 105.8% through 2019, as the share of those deaths involving fentanyl increased from 16.4% to 72.9%. This letter seeks to determine whether the opioid prescribing and mortality paradox is robust to accepted methods of causal policy analysis and if prescribing rates mediate the effects of policy interventions on overdose deaths. Using loge-loge ordinary least squares with three different specifications as sensitivity analyses for all 50 states and Washington, DC for the period 2001-2019, the elasticities from the regressions with all control variables report operational prescription drug monitoring programs (PDMPs) reduce prescribing rates 8.7%, while mandatory PDMPs increase death rates from opioids 16.6%, heroin and fentanyl 19.0%, cocaine 17.3% and all drugs 10.5%. There is also weak evidence that recreational marijuana laws reduce prescribing, increases in prescribing increase pain reliever deaths, pill mill laws increase cocaine deaths, and medical marijuana laws increase total overdose deaths, with demographic variables suggesting states with more male, less non-Hispanic white, and older citizens experience more overdoses. Weak mediation effects were observed for pain reliever, cocaine, and illicit opioid deaths, while broad reductions in prescribing have failed to reduce opioid overdoses.

DOI: https://doi.org/10.1016/j.jadohealth.2020

Effect of cannabis liberalization on suicide and mental illness following recreational access: a state-level longitudinal analysis in the USA

Objective: To standardize the implementation dates of various cannabis liberalization policies and determine whether previous research by Anderson et al. [D.M. Anderson, D.I. Rees, J.J. Sabia, American Journal of Public Health 104, 2369-2376] on medical marijuana access and population-level suicidality is robust to additional years of data and further cannabis liberalization in the form of recreational marijuana access.

Design: A state-level longitudinal (panel) analysis. Suicide mortality rates from the National Center for Health Statistics and mental health morbidity rates from the National Survey on Drug Use and Health were employed with the procedures outlined by Anderson et al., using weighted ordinary least squares for three different specifications with various combinations of control variables as a sensitivity analysis to test for robustness.

Setting: All 50 states and Washington, DC for the period 1999-2019.

Participants: USA population.

Interventions: Cannabis liberalization policies in the form of recreational or medical access.

Primary and Secondary Outcome Measures: State-level population mental health outcomes in the form of suicide mortality among various age groups for males and females defined by the International Classification of Diseases, Tenth Revision and rates of mental illness, serious mental illness, major depression, and suicidal ideation defined by the Substance Abuse and Mental Health Services Administration.

Results: Recreational marijuana access was associated with a 6.29% reduction (95% CI −11.82% to −0.42%) in suicide rates for males in the 40 to 49 age group. No other mental health outcomes were consistently affected by cannabis liberalization.

Conclusions: Adverse mental health outcomes do not follow cannabis liberalization at the state level, confirming the findings of Anderson et al. In addition, there is evidence that recreational marijuana access reduces suicide rates for middle-aged males.

DOI: https://doi.org/10.1101/2020.09.25.20201848

Published Research:

Gaiha et al. Response [to “Association Between Youth Smoking, Electronic Cigarette Use, and COVID-19”]

A recent analysis by Gaiha et al. concluded that “COVID-19 is associated with youth use of e-cigarettes only and dual use of e-cigarettes and cigarettes.” Increasing rates of e-cigarette use among youth and young adults amid a respiratory pandemic should concern regulators interested in improving public health. However, the association reported by Gaiha et al. is not necessarily indicative of a causal relationship between e-cigarette use and contracting COVID-19. The research design uses a multivariate logistic regression, which is standard among epidemiological studies evaluating binary outcome variables, such as testing positive or negative for COVID-19. But the odds ratios (ORs) are calculated with the entire survey population, regardless of whether respondents were tested for COVID-19.

DOI: https://doi.org/10.1016/j.jadohealth.2020

"An Introduction to the Language of Mathematics"

This textbook is a revision of Dr. Paul Howard's course notes in Introduction to Mathematical Proofs. I have added revisions, more examples, and practice problems to the original course to supplement instruction. Dr. Howard's course was essential to my understanding of mathematics and is provided below free of charge to anyone who has the discipline to teach themselves.

Textbook: The Language of Mathematics