DECRIMINALIZE DRUGS

Medicaid unwinding associated with less medication treatment for opioid use disorder

Findings may have relevance for upcoming Medicaid cuts

THE STATE OF CRUELTY

RAND Corporation

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The end of pandemic-era enrollment enhancements for Medicaid was associated with a rise in the number of people ending medication treatment for opioid use disorder, as well as a decrease in the number of people beginning such treatment, according to a new RAND study.

 

While some people who disenrolled from Medicaid may have found other methods to pay for drug treatment, the overall number of those initiating and continuing medication treatment for opioid use disorder declined in the six months after Medicaid unwinding began. The changes were greatest in states that have had the largest disenrollments.

 

The study tracked treatment episodes of the opioid use disorder medication buprenorphine from 2021 to 2023 as pandemic-era Medicaid enrollment protections were phased out. The study authors say the findings have relevance given the recent federal legislation expected to result in 10 million Americans losing their Medicaid health coverage by 2034.

 

The study is published in the Journal of Addiction Medicine.

 

“These findings are particularly salient at a time when policy changes are increasing uncertainty about Medicaid coverage for many individuals,” said Bradley D. Stein, the study’s corresponding author and a senior physician policy researcher at RAND, a nonprofit research organization. “To sustain progress the nation has made against the opioid overdose crisis, it is essential to ensure that individuals who can benefit from life-saving medication continue to receive it.”

 

Medication treatment is the most-effective treatment for people battling addiction to fentanyl and other opioids, with buprenorphine being one commonly prescribed treatment for individuals with opioid use disorder. Medicaid covers approximately 40% of treatment for Americans with opioid use disorder.

 

More than 25 million Americans have disenrolled from Medicaid as a result of Medicaid unwinding -- the process in which states resumed normal Medicaid enrollment procedures after a period of continuous coverage mandated during the COVID-19 pandemic.

 

To examine the role that unwinding played in medication treatment for opioid use disorder, RAND researchers examined prescriptions dispensed at retail pharmacies in all 50 states and the District of Columbia to identify buprenorphine treatment episodes from Jan. 1, 2021 to Dec. 31, 2023.

 

About 45% of the buprenorphine treatment episodes were paid for by Medicaid, 18% by commercial insurance, 11% by Medicare, 11% by discount cards/vouchers, and 6% were cash-pay. Approximately 27% of treatment episodes were in high-unwinding states, 41% in moderate-unwinding states, and 31% in low-unwinding states.

 

On average, there were 3% more treatment episodes paid for by Medicaid that ended after unwinding began as compared to before unwinding. In states with the greatest unwinding, the percentage difference was more than double that in states with moderate or low levels of unwinding.

 

There were 2.6% fewer new treatment episodes paid for by Medicaid in the six months after unwinding compared to six months before unwinding. There was a significant 3.9% decrease in new treatment episodes paid for by Medicaid in states with the greatest unwinding, compared to a 2.4% decrease in states with moderate unwinding, and a 2% decrease in states with the smallest amount of unwinding.

 

Changes in treatment episodes paid for by Medicaid appear not to be completely offset by changes in reimbursement from other sources, such as individuals losing Medicaid paying out-of-pocket for buprenorphine or obtaining commercial insurance.

 

“These changes were associated with an increase in the number of Medicaid enrollees stopping buprenorphine treatment and a decrease in enrollees beginning it,” said Rachel K. Landis, study coauthor and policy researcher at RAND. “Consistent with research on total buprenorphine fills, effects were greatest in states with the greatest Medicaid disenrollment.”

 

Research reported in this press release was supported by the National Institute on Drug Abuse of the National Institutes of Health under award number P50DA04635108. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Support for the study was also provided by the Foundation for Opioid Response Efforts (FORE).

Another author of the study is Flora Sheng.

RAND Health Care promotes healthier societies by improving health care systems in the United States and other countries.

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Journal

Journal of Addiction Medicine

DOI

10.1097/ADM.0000000000001573 

Method of Research

Data/statistical analysis

Subject of Research

People

Article Title

Medicaid Unwinding: Association With New and Ending Buprenorphine Treatment Episodes

 

Rapid flash Joule heating technique unlocks efficient rare‑earth element recovery from electronic waste

New gas‑solid separation method promises cleaner, cheaper recycling of critical elements

Rice University

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image: 

A team of researchers including Rice University’s James Tour and Shichen Xu has developed an ultrafast, one-step method to recover rare earth elements (REEs) from discarded magnets using an innovative approach that offers significant environmental and economic benefits over traditional recycling methods. 

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Credit: Photo by Jeff Fitlow/Rice University.

A team of researchers including Rice University’s James Tour and Shichen Xu has developed an ultrafast, one-step method to recover rare earth elements (REEs) from discarded magnets using an innovative approach that offers significant environmental and economic benefits over traditional recycling methods. Their study was published in the Proceedings of the National Academy of Sciences Sept. 29, 2025.

Conventional rare earth recycling is energy-heavy and creates toxic waste. The research team’s method uses flash Joule heating (FJH), which rapidly raises material temperatures to thousands of degrees within milliseconds, and chlorine gas to extract REEs from magnet waste in seconds without needing water or acids. The breakthrough supports U.S. efforts to boost domestic mineral supplies.

“We’ve demonstrated that we can recover rare earth elements from electronic waste in seconds with minimal environmental footprint,” said Tour, the T.T. and W.F. Chao Professor of Chemistry, professor of materials science and nanoengineering and study corresponding author. “It’s the kind of leap forward we need to secure a resilient and circular supply chain.”

Hypothesis rooted in thermodynamic selectivity

The researchers proposed that FJH combined with chlorine gas could take advantage of differences in Gibbs free energy, a measure of a material’s reactivity, and varying boiling points to selectively remove non-REE elements from magnet waste.

In the presence of chlorine gas, elements such as iron or cobalt would chlorinate and vaporize first, leaving the REE oxides behind. The research team tested this process on neodymium iron boron and samarium cobalt magnet waste using ultrafast FJH under a chlorine atmosphere. By precisely controlling the temperatures and heating the materials within seconds, the non-REE elements were converted into volatile chlorides, which then separated from the solid REEs.

The scientists observed that the nonrare earth elements were removed almost instantaneously, enabling the recovery of a purer rare-earth residue.

“The thermodynamic advantage made the process both efficient and clean,” said Xu, the first author of the study and a postdoctoral associate at Rice. “This method not only works in tiny fractions of the time compared to traditional routes, but it also avoids any use of water or acid, something that wasn’t thought possible until now.”

In addition to laboratory experiments, the researchers conducted a comprehensive life cycle assessment (LCA) and techno-economic analysis (TEA) to benchmark their process. They achieved over 90% purity and yield for REE recovery in a single step. The LCA and TEA revealed an 87% reduction in energy use, an 84% decrease in greenhouse gas emissions and a 54% reduction in operating costs compared to hydrometallurgy. 

The process eliminates the need for water and acid inputs entirely, according to the study.

Toward scalable, circular rare‑earth economy

The new method makes it possible to build small or large, easy-to-use recycling units that can be placed close to where electronic waste is collected. These local systems can process used magnets quickly and cleanly, cutting down on shipping costs and helping the environment.

“The results show that this is more than an academic exercise — it’s a viable industrial pathway,” Tour said. 

This Rice intellectual property has been licensed to Flash Metals USA, a startup company in Texas’ Chambers County that will be in production mode by the first quarter of 2026 to capitalize on this process.  

Co-authors of the study include Rice’s Justin Sharp, Bing Deng, Qiming Liu, Lucas Eddy, Weiqiang Chen, Jaeho Shin, Shihui Chen, Haoxin Ye, Khalil JeBailey, Bowen Li, Tengda Si and Kai Gong.

This research was supported by the Defense Advanced Research Projects Agency, the Air Force Office of Scientific Research and the U.S. Army Corps of Engineers.

A team of researchers including Rice University’s James Tour and Shichen Xu has developed an ultrafast, one-step method to recover rare earth elements (REEs) from discarded magnets using an innovative approach that offers significant environmental and economic benefits over traditional recycling methods. 

Credit

Photo by Jeff Fitlow/Rice University.

Journal

Proceedings of the National Academy of Sciences

DOI

10.1073/pnas.2507819122 

Article Title

Sustainable separation of rare earth elements from wastes

Article Publication Date

29-Sep-2025

 

Scientists successfully recreate wildfire-induced thunderstorms in Earth system models for the first time

The breakthrough enhances scientific understanding of the dangerous storms and their long-term impacts on the climate

Desert Research Institute

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A developing pyrocumulonimbus cloud above Oregon's Gulch Fire, part of the Beaver Complex Fire, in 2014. 

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Credit: NASA

On September 5, 2020, California’s Creek Fire grew so severe that it began producing it’s own weather system. The fire’s extreme heat produced an explosive thunderhead that spewed lightning strikes and further fanned the roaring flames, making containment elusive and endangering the lives of firefighters on the ground. These wildfire-born storms have become a growing part of fire seasons across the West, with lasting impacts on air quality, weather, and climate. Until now, scientists have struggled to replicate them in Earth system models, hindering our ability to predict their occurrence and understand their impacts on the global climate. Now, a new study provides a breakthrough by developing a novel wildfire-Earth system modeling framework.  

The research, published September 25th in Geophysical Research Letters, represents the first successful simulation of these wildfire-induced storms, known as pyrocumulonimbus clouds, within an Earth system model. Led by DRI scientist Ziming Ke, the study successfully reproduced the observed timing, height, and strength of the Creek Fire’s thunderhead – one of the largest known pyrocumulonimbus clouds seen in the U.S., according to NASA. The model also replicated multiple thunderstorms produced by the 2021 Dixie Fire, which occurred under very different conditions. Accounting for the way that cloud development is aided by moisture lofted into the higher reaches of the atmosphere by terrain and winds is key to their findings.   

“This work is a first-of-its-kind breakthrough in Earth system modeling,” Ke said. “It not only demonstrates how extreme wildfire events can be studied within Earth system models, but also establishes DRI’s growing capability in Earth system model development — a core strength that positions the institute to lead future advances in wildfire–climate science.”  

When a pyrocumulonimbus cloud forms, it injects smoke and moisture into the upper atmosphere at magnitudes comparable to those of small volcanic eruptions, impacting the way Earth’s atmosphere receives and reflects sunlight. These fire aerosols can persist for months or longer, altering stratospheric composition. When transported to polar regions, they affect Antarctic ozone dynamics, modify clouds and albedo, and accelerate ice and snow melt, reshaping polar climate feedbacks. Scientists estimate that tens to hundreds of these storms occur globally each year, and that the trend of increasingly severe wildfires will only grow their numbers. Until now, failing to incorporate these storms into Earth system models has hindered our ability to understand this natural disturbance’s impact on global climate. 

The research team also included scientists from Lawrence Livermore National Laboratory, U.C. Irvine, and Pacific Northwest National Laboratory. Their breakthrough leveraged the Department of Energy’s (DOE) Energy Exascale Earth System Model (E3SM) to successfully capture the complex interplay between wildfires and the atmosphere.  

“Our team developed a novel wildfire–Earth system modeling framework that integrates high-resolution wildfire emissions, a one-dimensional plume-rise model, and fire-induced water vapor transport into DOE’s cutting-edge Earth system model,” Ke said. “This breakthrough advances high-resolution modeling of extreme hazards to improve national resilience and preparedness, and provides the framework for future exploration of these storms at regional and global scales within Earth system models.” 

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More information: The full study, Simulating Pyrocumulonimbus Clouds Using a Multiscale Wildfire Simulation Framework, is available from Geophysical Research Letters at https://agupubs.onlinelibrary.wiley.com/doi/10.1029/2024GL114025 

Study authors include: Ziming Ke (DRI/Lawrence Livermore National Lab), Qi Tang (Lawrence Livermore National Lab), Jishi Zhang (Lawrence Livermore National Lab), Yang Chen (UC Irvine), James Randerson (UC Irvine), Jianfeng Li (Pacific NW National Lab), Yunyan Zhang (Lawrence Livermore National Lab) 

About DRI 

We are Nevada’s non-profit research institute, founded in 1959 to empower experts to focus on science that matters. We work with communities across the state — and the world — to address their most pressing scientific questions. We’re proud that our scientists continuously produce solutions that better human and environmental health.   

Scientists at DRI are encouraged to follow their research interests across the traditional boundaries of scientific fields, collaborating across DRI and with scientists worldwide. All faculty support their own research through grants, bringing in nearly $5 to the Nevada economy for every $1 of state funds received. With more than 600 scientists, engineers, students, and staff across our Reno and Las Vegas campuses, we conducted more than $52 million in sponsored research focused on improving peoples’ lives in 2024 alone. 

At DRI, science isn’t merely academic — it’s the key to future-proofing our communities and building a better world. For more information, please visit www.dri.edu. 

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Journal

Geophysical Research Letters

Article Title

Simulating Pyrocumulonimbus Clouds Using a Multiscale Wildfire Simulation Framework

Article Publication Date

25-Sep-2025