August 14, 2020 - Podcast

Episode 20—Marking the Americans with Disabilities Act, and youth and opioids

July marked 30 years since the Americans with Disabilities Act was signed into law. But Mary Ciccarelli, a clinical medicine and pediatrics professor at the Indiana University School of Medicine, says while the U.S. has come far in meeting the Act’s goals of health equity, it still has a ways to go. Furthermore, the current pandemic has worsened existing inequities for people with disabilities. In general, Ciccarelli says people with disabilities have less access to care, due to a combination of factors, including difficulties navigating difficult systems of care, lack of physical adaptations in clinical facilities, difficulties accessing transportation, and more. COVID-19 has added another layer, she says. Higher rates of preexisting health conditions could result in more severe cases of COVID within the disability population. Some with intellectual or development disabilities may have more difficulties than the general population with adapting to mask wearing, avoiding touching of surfaces or social distancing. Because a significant proportion of adults with intellectual disabilities live with older parents as their caregivers, they create higher risks to their caregivers if they cannot safely follow the recommended safety measures. Anxiety, as a mental health condition, occurs at higher rates among people with disabilities, Ciccarelli says, and we are seeing the pandemic as a trigger of many people’s anxiety. While the U.S. continues to make strides, Ciccarelli says, to truly ensure health equity, we need better systems of population health, better research and better real-time information for patients, caregivers and health professions. Communication and education are big pieces of this puzzle, including the training of clinicians in all settings to adapt effectively in serving people with disabilities.

In other news, young adults and adolescents who are prescribed opioids for the first time may be at a slightly greater risk of developing a substance-related problem later in life, according to a new study by Indiana University researchers. However, that risk may not be as high as previously thought. A study by Patrick Quinn, an assistant professor at the IU School of Public Health, looked at the health records of Swedish individuals, age 13 to 29, who were prescribed opioids for the first time. Quinn’s team conducted a number of tests, including comparing youth and adolescents who were prescribed opioids with those whose pain was treated with a non-opioid pain medication. They also compared twins and other siblings of multiple births, one who was prescribed opioids and others who were not. They found that across the board, the opioid recipients' risk was 1 to 2 percent greater than other people's risk. Quinn says although the research found that there was not a big difference, it still shows that even a first opioid prescription may lead to some risk. The findings, highlight the importance of screening for substance use disorders and other mental health conditions among patients with pain, including those receiving opioid therapy.