Research spotlight: regional disparities in opioid overdose mortality persist despite US national decline

Mass General Brigham

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Sarah Wakeman, MD, Senior Medical Director for Substance Use Disorder at Mass General Brigham, is the co-senior author and Will Oles, BS, of Harvard Medical School, is a corresponding author of a paper published in the Journal of General Internal Medicine, “Geographic Trends in Opioid and Polysubstance Overdose Deaths in the US, 2014-2023.” 

Q: How would you summarize your study for a lay audience? 

In May 2024, the Centers for Disease Control (CDC) announced a national decline in the rate of drug overdose deaths for the first time since 2018. However, little is known about how this decline varies by geographic region.  

To address this gap, we analyzed US opioid overdose deaths by region, finding that opioid-related mortality increased in the western US despite a decrease in other regions between 2022 and 2023.  

This regional divergence was driven by an increase in overdoses due to fentanyl or a combination of fentanyl and stimulants (e.g., methamphetamine).  

These findings highlight the evolving nature of the overdose crisis and suggest the need for region-specific strategies to address differing patterns of substance use and overdose risk. 

Q: What knowledge gap does your study help to fill? 

Given recent reports of national improvements in opioid-related mortality, we sought to understand how trends in opioid overdoses––particularly those involving combinations of opioids with other substances––have shifted over time across different regions of the US. 

Q: What methods or approach did you use? 

We examined publicly available death certificate data from the CDC’s WONDER database to identify all opioid-related deaths reported in the US between 2014 and 2023.  

Q: What did you find? 

Between 2022 and 2023, we found that opioid overdose deaths decreased in non-West regions but continued to rise in the western US by 14%.  

Beginning in 2019, rates of overdoses that co-involved both fentanyl and a stimulant accelerated across all US regions.  

Overdoses involving fentanyl and cocaine were more common in non-West regions, while overdoses involving fentanyl and methamphetamine were more common in the West.  

Nationally, around one in three fentanyl-related deaths now involve stimulants, with states in the West nearing one in two. 

Q: What are the implications? 

Our findings of a continued increase in opioid overdose deaths in the West, masked by a decline in mortality nationally, underscore an ongoing shift in the landscape of the opioid overdose crisis.  

The emergence of these distinct overdose patterns highlight the need for ongoing surveillance of these substances in local drug markets, equitable access to medications for opioid use disorder and investment in therapies for stimulant use disorder. 

Q: What are the next steps? 

Ongoing surveillance of regional opioid mortality trends will be essential as new data emerges nationally. Future research should also investigate the root causes of geographic disparities to help guide targeted public health responses and inform policy development. 

 

Authorship: In addition to Wakeman and Oles, additional authors include Michael Liu and Marc Larochelle. 

Paper cited: Oles W C, et al. “Geographic Trends in Opioid and Polysubstance Overdose Deaths in the US, 2014-2023” Journal of General Internal Medicine. DOI: 10.1007/s11606-025-09589-1 

Funding: N/A 

Disclosures: Dr. Wakeman reported being an author for UpToDate and a textbook editor for Springer and Wolters Kluwer.

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Journal

Journal of General Internal Medicine

DOI

10.1007/s11606-025-09589-1 

Article Title

Research Spotlight: Regional Disparities in Opioid Overdose Mortality Persist Despite National Decline

 

Fighting myeloma with fiber: Plant-based diet offers promise

A high-fiber diet improved health markers that could delay progression to cancer

American Society for Nutrition

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Francesca Castro, a clinical research dietitian at Memorial Sloan Kettering Cancer Center

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Credit: Francesca Castro, Memorial Sloan Kettering Cancer Center

Results from a new clinical trial suggest that a high-fiber plant-based diet could benefit patients at risk for developing multiple myeloma, the second most common type of blood cancer. The study showed that the diet was not only feasible and well-received but also improved several factors that could potentially delay the progression of precancerous conditions that can lead to multiple myeloma.  

 

Multiple myeloma is often preceded by early, non-cancerous conditions involving abnormal plasma cells, a type of white blood cell found in the bone marrow. Having a high body weight, a poor-quality diet and an unhealthy balance of gut bacteria have been shown to increase the risk of developing these conditions and progressing to multiple myeloma.

 

“With cancers being detected earlier and precancerous states identified more frequently, there is a growing opportunity to understand how modifiable risk factors—like diet and lifestyle—affect cancer progression,” said Francesca Castro, a clinical research dietitian at Memorial Sloan Kettering Cancer Center. “Our results highlight the importance of improved dietary quality in early disease states and could provide guidance for future clinical trials.” 

 

Castro will present the findings at NUTRITION 2025, the flagship annual meeting of the American Society for Nutrition held May 31–June 3 in Orlando.

 

Current research in patients at risk for myeloma tends to focus on identifying genomic and immune drivers of progression and therapy options for people with the precursor conditions.

 

“With everything that patients cannot control during and before cancer treatment, studying diet provides an opportunity for patients to make a difference in their disease risk and the potential success of their treatment,” said Urvi A. Shah, MD, a physician scientist at Memorial Sloan Kettering Cancer Center and principal investigator for the research. “Our study shows the power of nutrition in the preventative setting and showcases the potential to give patients a sense of agency in their diagnosis.”

 

The pilot study, which is part of the NUTRIVENTION Trials, included 20 patients at risk for developing multiple myeloma due to precursor conditions and an elevated body mass index. Patients received 12 weeks of high-fiber, plant-based meals, 24 weeks of individualized nutritional counseling and were followed for 52 weeks.

 

Study participants were encouraged to eat to satiety as long as they consumed whole plant-based foods such as fruits, vegetables, nuts, seeds, whole grains and legumes. They were also asked to avoid refined grains, animal products, added sugar and highly processed foods.

 

The researchers found that the high-fiber, plant-based diet was feasible and well-received, leading to dietary adherence and weight loss. Before the study began, only 20% of total calories were from high-fiber plant-based foods whereas by the end of the 12-week dietary intervention, that number jumped to 91%. At 12 weeks, the median participants’ BMI of had dropped 7% and this weight loss was sustained at 1 year. In addition, two patients experienced a slowing of disease progression while progression remained stable in the others.

 

The investigators also observed significant improvements in dietary quality, quality of life, metabolic markers such as insulin resistance and lipid profiles, inflammation, and the diversity and composition of the gut microbiome. These improvements were still observable at the end of the 12-week intervention and sustained through the 52-week follow-up.

 

“Our study had diverse racial enrollment as well as a comprehensive dietary and biomarker evaluation,” said Shah. “Our comprehensive analysis of improved immune and metabolic response suggests that a high-fiber plant-based diet can also reduce risk for cardiovascular conditions, diabetes and other metabolic conditions.”

 

When consuming fiber, most Americans fall short of the around 28 grams per day recommended by the US Dietary Guidelines. To boost fiber in the diet, the researchers suggest setting realistic daily goals and focusing on one meal at a time.

 

“Think about what foods you can add or swap to increase fiber intake,” said Castro. “It can be very simple like adding a piece of fruit at the end of a meal or swapping out a refined grain for a whole grain. Eating more fiber can lower risk for many other conditions and can improve overall health, beyond just reducing cancer risk.”

 

The investigators are currently enrolling participants in follow-up NUTRIVENTION Trials to evaluate the potential effects of a high-fiber, plant-based diet in larger groups of patients and to investigate the effects of diet versus supplements on the gut microbiome. They also plan to study the effects of the high-fiber plant-based diet on other precursor blood conditions, such as clonal hematopoiesis, which increases risk for other blood cancers, such as leukemia.

Urvi A. Shah, MD, a physician scientist at Memorial Sloan Kettering Cancer Center

Credit

Urvi A. Shah, Memorial Sloan Kettering Cancer Center

Castro will present this research at 4:12 – 4:24 p.m. EDT on Monday, June 2, during the Role of Diet in Cancer Prevention and Control session in the Orange County Convention Center (abstract; presentation details).

 

Please note that abstracts presented at NUTRITION 2025 were evaluated and selected by a committee of experts but have not generally undergone the same peer review process required for publication in a scientific journal. As such, the findings presented should be considered preliminary until a peer-reviewed publication is available.

 

About NUTRITION 2025

NUTRITION 2025 is the flagship meeting of the American Society for Nutrition and the premier educational event for nutritional professionals around the globe. NUTRITION brings together lab scientists, practicing clinicians, population health researchers and community intervention investigators to identify solutions to today’s greatest nutrition challenges. Our audience also includes rising leaders in the field – undergraduate, graduate and medical students. NUTRITION 2025 will be held May 31– June 3 in Orlando. https://nutrition.org/meeting/ #Nutrition2025

 

About the American Society for Nutrition (ASN)

ASN is the preeminent professional organization for nutrition research scientists and clinicians around the world. Founded in 1928, the society brings together the top nutrition researchers, medical practitioners, policy makers and industry leaders to advance our knowledge and application of nutrition. ASN publishes four peer-reviewed journals and provides education and professional development opportunities to advance nutrition research, practice, and education. Since 2018, the American Society of Nutrition has presented NUTRITION, the leading global annual meeting for nutrition professionals. http://www.nutrition.org

 

Find more news briefs from NUTRITION 2025 at: https://www.eurekalert.org/newsroom/nutrition2025.

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What makes someone leave a Medicare Advantage plan?

Problems with accessing high-quality care count more than problems with costs, study finds

Michigan Medicine - University of Michigan

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More than half of older Americans now get their Medicare coverage through an insurance company’s Medicare Advantage plan. But many go on to switch plans or even leave for traditional Medicare when Open Enrollment comes around each autumn.

Researchers have had a hard time getting access to data that could help them understand what drives these changes, which have major implications for federal spending on Medicare as well as individuals’ health.

Now, a new study in the June issue of Health Affairs peels back the curtain on what motivates people to switch MA plans or leave MA altogether.

The inability to access the care they needed, and dissatisfaction with the quality of the care they received, had much more to do with switching to another MA plan than the costs they had to pay, the study finds.

But access issues were much more likely to drive someone out of MA completely and back to traditional Medicare.

Dissatisfaction with access was much more common among people who say their health is poor - a group that other studies have shown to have the highest rates of MA plan switching and exits.

Geoffrey Hoffman, Ph.D., the lead author of the new study and an associate professor in the U-M School of Nursing, says the study also shows that people who enrolled in an MA plan with a low star rating – which they may or may not have been aware of unless they checked Medicare’s Plan Finder – were also more likely to switch.

“The idea of the private market for Medicare Advantage plans is that people are supposed to shop around as their needs evolve, but with medical care you likely need to experience it before you know whether you want to switch,” he said. “We show that people who stay in MA are shopping for better service, but that those who switch to traditional Medicare are the ones potentially with high health care needs, who are much more strongly driven by dissatisfaction with access to care issues in MA.”

The new findings about people in poor health leaving for traditional Medicare confirm research by others, but in a patient-centered way instead of one based on billing. That’s because Hoffman and his colleagues used anonymous data about satisfaction with medical care access, cost, and quality from surveys that Medicare beneficiaries take each year, and linked it to anonymous data about MA enrollment.

The new study also suggests that the star ratings system, which assigns one to five stars to each MA plan based on a combination of data including participant surveys, can be a good guide to help people choose a plan.

“While imperfect, the star rating a plan receives is still signaling something important, that our study tells us is definitely linked to why people are switching,” Hoffman said.

But he also notes that plan generosity – a measure that people picking Medicare options don’t have easy access to – also predicted switching behavior, with people in more-generous plans less likely to switch.

Dissatisfied customers

The new study shows that those who left their MA plan for any other form of Medicare were much more likely than those who stayed with their plan to say they had had trouble getting care they needed, and were dissatisfied with the cost of their care and the quality of their care.

Those who said their health is poor were more than twice as likely as other MA enrollees to say they had trouble getting care they needed, more than three times as likely to be dissatisfied with the quality of their care, and more than twice as likely to be dissatisfied with the cost of their care and with their specialty care. About 15% of the study sample reported being in poor health.

But overall, dissatisfaction with cost wasn’t associated with leaving a MA plan. Access to care and quality of care were – as were enrollment in a plan with a low star rating and low generosity of benefits.

Those who said they were having trouble accessing needed care were much more likely to switch from MA to traditional Medicare, which does not limit the selection of doctors and hospitals that enrollees can visit. Costs may be less of an issue in switching behavior given that, unlike traditional Medicare, MA plans have caps on enrollees’ out-of-pocket costs.

The switching of people with high health needs to traditional Medicare has major implications for how the government handles payment to the insurance companies that run MA plans, as well as for the funding for traditional Medicare itself. When more costly beneficiaries leave MA, traditional Medicare is left with the expensive bill.

It also makes a difference for beneficiaries’ out-of-pocket costs, since only some states allow people who leave MA to get unrestricted access to a Medigap plan that they can layer on top of traditional Medicare.

In other words, people who have major health issues and wanting to enroll in traditional Medicare after being in MA may not be able to qualify for Medigap coverage depending on what state they live in. This means those exiting MA for traditional Medicare may get stuck with more medical bills because they cannot get supplemental coverage to cover cost-sharing. Medigap plans are also products of private insurance companies.

The study used Medicare Current Beneficiary Survey data linked to anonymized information about the 3,600 people whose surveys they reviewed; the surveys had been taken after the individuals had been in their Medicare Advantage plan for at least 8 months. The researchers excluded data from some groups of older adults with special circumstances such as eligibility for Medicare for people with low incomes, and people enrolled in Medicare before age 65 because of disability or kidney failure.

The senior author of the paper is Deborah Levine, M.D., M.P.H., a professor in the U-M Medical School’s Department of Internal Medicine in the Division of General Medicine. Other authors are Lianlian Lei, Ph.D., Ishrat Alam, Ph.D., Myra Kim, Sc.D., Lillian Min, M.D., MSHS, and Zhaohui Fan, M.D., MPH. Most of the authors are members of the U-M Institute for Healthcare Policy and Innovation.

The study was supported by the National Institute on Aging of the National Institutes of Health (R01AG074944).

Medicare Advantage Plan Disenrollment: Beneficiaries Cite Access, Cost, And Quality Among Reasons For Leaving, Health Affairs, DOI:10.1377/hlthaff.2024.01536

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Journal

Health Affairs

DOI

10.1377/hlthaff.2024.01536 

Method of Research

Data/statistical analysis

Subject of Research

People

Article Title

Medicare Advantage Plan Disenrollment: Beneficiaries Cite Access, Cost, And Quality Among Reasons For Leaving

Article Publication Date

2-Jun-2025

 

Virginia Tech researchers develop recyclable, healable electronics

Electronics often get thrown away after use because recycling them requires extensive work for little payoff. Two Virginia Tech researchers have found a way to change the game

Virginia Tech

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(From left) Ravi Tutika, Michael Bartlett, Josh Worch, and Meng Jiang test the recyclable circuit created by the teams from mechanical engineering and chemistry.

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Credit: Photo by Alex Parrish for Virginia Tech.

Between upgrades and breakdowns to cellphones, tablets, laptops, and appliances, so many electronics are getting tossed in the trash that they've taken on a name of their own: e-waste.

According to a 2024 report issued by the United Nations, the amount of e-waste worldwide has almost doubled in the past 12 years, from 34 billion to 62 billion kilograms — the equivalent of 1.55 million shipping trucks — and it's estimated to hit 82 billion kilograms by 2030. Just 13.8 billion kilograms — about 20 percent of the total — is expected to be recycled, a number projected to remain flat. 

Put simply, we’re throwing away more and more electronics, and recycling isn’t keeping up. But a new study in Advanced Materials by two Virginia Tech research teams offers a potential solution to the e-waste problem: a recyclable material that could make electronics easier to break down and reuse.

Chemistry and engineering have an answer

Michael Bartlett, associate professor of mechanical engineering, and Josh Worch, assistant professor of chemistry, come from different fields, but together they created a new class of circuit materials. With significant work from their team of postdoctoral and graduate student researchers, including Dong Hae Ho, Meng Jiang, and Ravi Tutika, the new circuits are recyclable, electrically conductive, reconfigurable, and self-healing after damage. Yet they retain the strength and durability of traditional circuit board plastics — features rarely found together in a single material. 

The new material starts with a vitrimer, a dynamic polymer that can be reshaped and recycled. This versatile material is combined with droplets of liquid metal that do the work of carrying the electric current, the way rigid metals do in a traditional circuit.  

This is a fundamentally different approach from other recyclable or flexible electronics. By combining the high-performance, adaptable polymers with electrically conductive liquid metals, the new circuit holds up under a host of challenges.

“Our material is unlike conventional electronic composites,” said Bartlett. “The circuit boards are remarkably resilient and functional. Even under mechanical deformation or damage, they still work.”

A second life

Recycling traditional circuit boards involves several energy-intensive deconstruction steps and still yields large amounts of waste. Billions of dollars of valuable metal components are lost in the process.

Recycling the team's circuit board is straightforward and can be accomplished in multiple ways.

“Traditional circuit boards are made from permanent thermosets that are incredibly difficult to recycle,” said Worch. “Here, our dynamic composite material can be healed or reshaped if damaged by applying heat, and the electrical performance will not suffer. Modern circuit boards simply cannot do this.”

The vitrimer circuit boards also can be deconstructed at their end of life using alkaline hydrolysis, enabling recovery of key components such as the liquid metal and LEDs. Fully reusing all components of the conductive composites in a closed-loop process remains a goal for future research.

While it may not be possible to curb the amount of electronics that are discarded by the world's consumers, this work represents a key step toward keeping more electronics out of landfills. 

This research was supported by Virginia Tech through the Institute for Critical Technology and Applied Science and Bartlett’s National Science Foundation Early Faculty Career Development (CAREER) award.

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Journal

Advanced Materials

DOI

10.1002/adma.202501341 

Method of Research

Experimental study

Subject of Research

Not applicable

Article Title

Liquid Metal-Vitrimer Conductive Composite for Recyclable and Resilient Electronics

Article Publication Date

1-Jun-2025