Tara O'Neill Hayes, Ryan Manos for the American Action Forum: The fundamental problem driving the opioid crisis is abuse of both prescription opioids and the system used to obtain them. While the long-term over-prescription of opioids is now widely acknowledged by drug manufacturers, doctors and regulators, these same parties are now making efforts to curb abuse, with mixed results.
Pharmaceutical manufacturers have sought in some cases to modify the addictive nature and potential for abuse of their prescription opioids. One such example comes from the creator of Opana, Endo Pharmaceuticals, which reformulated the drug in 2012 to prevent patient abuse of the drug by crushing and snorting it. The reformulation added a protective coating to the pill so that would no longer be possible. This change had an unfortunate side effect, however: It led addicted users to begin injecting the drug intravenously. Opana’s experience shows that reformulating drugs may do little to halt abuse and in some cases may result in even more dangerous behavior.
Rather than alter the drug itself, prescribers and pharmacy benefit managers have begun to change their practices and guidelines to limit prescription lengths and dosages. The CDC recently published guidelines for prescribing opioids to establish an effective protocol while encouraging communication between patients and providers on the dangers of opioid abuse. CVS Caremark was an early adopter of these guidelines and has limited initial opioid prescriptions to seven days, with certain exceptions. The company also limits daily dosages and requires that immediate-release versions of opioid pharmaceuticals be provided prior to authorizing the use of extended-release opioids.
Skeptics of prescribing guidelines claim that they decrease access to pain medication that is necessary to maintain a positive quality of life. These critics argue that Americans who properly adhere to their prescriptions and only receive relief from pharmaceutical opioids are unfairly affected. Physicians also have voiced their displeasure with the administrative burden imposed by the Centers for Disease Control and Prevention's prescription guidelines. The modern healthcare trend toward emphasizing value rewards physicians for cost savings and requiring doctors to follow time-consuming — and thus costly — prescription guidelines without considering that quality metrics could penalize doctors or minimize adoption.
Three million Americans are in college 'deserts'
Victoria Rosenboom and Kristin Blagg for the Urban Institute: For people who do not have a university nearby, online education may be the only avenue to pursue higher education. We estimate that 41 million American adults lack access to a physical university, and of those, 3 million also lack access to an Internet connection suitable for online education. An additional 2 million adults lack access to online education but have a physical university nearby.
We define physical higher education deserts as areas where either there are no colleges or universities within 25 miles or there is a single community college as the only broad-access public institution within 25 miles. Using this definition, an area with a private institution and a selective public institution as the only two institutions within 25 miles would be defined as a physical education desert. We define online education deserts using the Federal Communications Commission’s benchmark for measuring broadband Internet access. Complete educations deserts are both physical and online education deserts. …
Although some students move to enroll in college, 38 percent of first-year students enroll at an institution less than 50 miles from their home. The farther prospective students live from a college or university, the less likely they are to enroll. Students with work or family obligations may be even less likely to move to enroll.
Only 1.3 percent of the U.S. population lives in a complete education desert, but 11.8 percent of American Indians and Alaska Natives live in complete education deserts.
Kenosha, Wis., shows the employment impact of Amazon
Michael Mandel for the Progressive Policy Institute: Amazon is the fastest U.S. company – and perhaps the fastest company anywhere – to 300,000 workers. Its rapid expansion is creating tech-enabled work in virtually every corner of the country, with our estimates showing that fulfillment center jobs pay 31 percent more, on average, than brick-and-mortar retail jobs in the same area.
Now, there are all sorts of interesting questions about what happens next. Some people have worried that the fulfillment center jobs will fade away as the operations get increasingly roboticized. By contrast, our view is that fulfillment centers will become critical hubs for the new “Internet of Goods:" By lowering the cost of shipping and creating a pool of tech-enabled workers, areas with e-commerce fulfillment centers will have a head start in attracting the next wave of manufacturing startups ...
Right around the time that Amazon arrives in Kenosha, Wis., county employment turns up, driven in large part by the increase in warehouse jobs.
Indeed, Kenosha County is effectively becoming a tech-enabled distribution-manufacturing hub. After Amazon opened its doors, the county attracted companies such as Haribo, the German candy giant and originator of gummy bears, which is building its first North American factory in Kenosha.