Douglas McDonald - Academia.edu (original) (raw)
Papers by Douglas McDonald
The Fortune Society, located in New York City, provides various services on a voluntary basis to ... more The Fortune Society, located in New York City, provides various services on a voluntary basis to offenders who have been incarcerated previously, at an average cost (in 2005) of about $3,265 per client. This study examines the extent to which receipt of these services reduces recidivism and homelessness following release. Recidivism is measured by an arrest leading to conviction; homelessness is indicated by a request to the NYC Department of Homeless Services for shelter. Fortune clients released to NYC from state prisons or from NYC jails during 2000-2005 are examined and their outcomes are compared to outcomes observed for state prisoners or local jail inmates released during same period but who did not go to Fortune. Multivariate survival analyses and propensity score analyses are used to estimate program effects on recidivism. No evidence of positive effects on recidivism is found. Indeed, Fortune clients were more likely to recidivate than non-clients, even after controlling f...
Military Medicine, 2020
IntroductionThe use and misuse of opioids by active service members has been examined in several ... more IntroductionThe use and misuse of opioids by active service members has been examined in several studies, but little is known about their spouses’ opioid use. This study estimates the number of military spouses who received high-risk or long-term opioid prescriptions between 2010 and 2014, and addresses how the Military Health System can help prevent risky prescribing in order to improve military force readiness.Materials and MethodsThis study used data from the Millennium Cohort Family Study, a nationwide survey of 9,872 spouses of service members with 2 to 5 years of military service, augmented with information from the military’s Pharmacy Data Transaction Service about prescriptions for controlled drugs dispensed to these service members’ spouses. Our objectives were to estimate the prevalence of opioid prescribing indicative of long-term use (≥60 day supply or at least one extended-release opioid prescription in any 3-month period) and, separately, high-risk use (daily dosage of...
Pain medicine (Malden, Mass.), Jan 30, 2018
This research looked at whether notifying prescribers and pharmacies about patients who use multi... more This research looked at whether notifying prescribers and pharmacies about patients who use multiple providers to obtain opioids reduces their prescribing activity (including use of multiple providers, numbers of opioid prescriptions, or amounts of opioids obtained). Nevada's prescription drug monitoring program (PDMP) identified patients using multiple providers to obtain opioids and assigned them alternately to an intervention or control group. Controlled substance prescription histories were sent only to intervention patients' providers. Subsequent opioid purchases by patients in both groups were compared. All pharmacies and dispensers in the state are required to report every prescription for Schedule II-IV opioids dispensed to the PDMP. All patients receiving opioids from more than four different Nevada prescribers and more than four pharmacies during the previous six months assigned to the intervention (N = 436) or control group (N = 441). We used ordinary least square...
Abstract : The report first maps out the different components which contribute to the organizatio... more Abstract : The report first maps out the different components which contribute to the organization of applied social research. Two chapters then compare various models by which research can be incorporated into an organization and review the factors which affect the various solutions. Finally, the work of policy science centers is singled out for special analysis. They are a recent and growing development; the implications of this trend are discussed. (Author)
Pharmacoepidemiology and drug safety, 2014
This study estimates the prevalence in US counties of opioid patients who use large numbers of pr... more This study estimates the prevalence in US counties of opioid patients who use large numbers of prescribers, the amounts of opioids they obtain, and the extent to which their prevalence is predicted by ecological attributes of counties, including general medical exposure to opioids. Finite mixture models were used to estimate the size of an outlier subpopulation of patients with suspiciously large numbers of prescribers (probable doctor shoppers), using a sample of 146 million opioid prescriptions dispensed during 2008. Ordinary least squares regression models of county-level shopper rates included independent variables measuring ecological attributes of counties, including rates of patients prescribed opioids, socioeconomic characteristics of the resident population, supply of physicians, and measures of healthcare service utilization. The prevalence of shoppers varied widely by county, with rates ranging between 0.6 and 2.5 per 1000 residents. Shopper prevalence was strongly correl...
Psychiatric Services, 2013
OBJECTIVE This study estimated the prevalence of stimulant treatment among both adults and childr... more OBJECTIVE This study estimated the prevalence of stimulant treatment among both adults and children at national, state, and county levels during 2008 and explored explanations for wide variations in treatment prevalence. METHODS Records of 24.1 million stimulant prescriptions dispensed to insured and uninsured patients were obtained from approximately 76% of U.S. retail pharmacies. Data were weighted to estimate treatment prevalence on March 15, 2008, for all U.S. states and counties. Regression models were used to estimate the associations among the counties' treatment rates and the characteristics of the counties and their resident populations. RESULTS An estimated 2.5% of children ≤ 17 years of age (3.5% of males and 1.5% of females) and .6% of persons >17 years of age were being treated with stimulants in March 2008. Treatment prevalence among states varied widely, and variation among counties was even wider. Two-thirds of the variation among counties in treatment prevalence was associated with supply of physicians, socioeconomic composition of the population, and, among children, funding for special education. Rates of children and adults in treatment were highly correlated. CONCLUSIONS Wide variations in treatment prevalence signal disparities between established clinical practice guidelines and actual practice, especially for primary care, where most patients prescribed stimulants are managed. Better education and training for physicians may improve identification and treatment, thereby reducing disparities in care for attention-deficit hyperactivity disorder and other disabling conditions.
The Journal of Pain, 2012
Estimates of geographic variation among states and counties in the prevalence of opioid prescribi... more Estimates of geographic variation among states and counties in the prevalence of opioid prescribing are developed using data from a large (135M) representative national sample of opioid prescriptions dispensed during 2008 by 37,000 retail pharmacies. Statistical analyses are used to estimate the extent to which county variation is explained by characteristics of resident populations, their healthcare utilization, proxy measures of morbidity, availability of healthcare resources, and prescription monitoring laws. Geographic variation in prevalence of prescribed opioids is large, greater than variation observed for other healthcare services. Counties having the highest prescribing rates for opioids were disproportionately located in Appalachia and in Southern and Western states. The number of available physicians was by far the strongest predictor of amounts prescribed, but only one-third of county variation is explained by the combination of all measured factors. Wide variation in prescribing opioids reflects weak consensus regarding the appropriate use of opioids for treating pain, especially chronic non-cancer pain. Patients' demands for treatment have increased, more potent opioids have become available, an epidemic of abuse has emerged, and calls for increased government regulation are growing. Greater guidance, education and training in opioid prescribing are needed for clinicians to support appropriate prescribing practices. Perspective-Wide geographic variation that does not reflect differences in the prevalence of injuries, surgeries, or conditions requiring analgesics raises questions about opioid prescribing practices. Low prescription rates may indicate under-treatment, while high rates may indicate overprescribing and insufficient attention to risks of misuse.
Federal Sentencing Reporter, 1994
Although the intent of the Sentencing Reform Act of 1984 ("SRA," hereafter) was to elim... more Although the intent of the Sentencing Reform Act of 1984 ("SRA," hereafter) was to eliminate disparities in sentences imposed by federal judges, differences in imprisonment sentences received by black, white, and Hispanic offenders grew more pronounced after full implementation of the guidelines. That is, imprison ment sentences meted out to blacks grew increasingly harsher, on average, relative to whites and Hispanics, during the first year and a half following full imple mentation of the guidelines (that is, after the U.S. Supreme Court's decision in Mistretta). At the request of the U.S. Department of Justice's Bureau of Justice Statistics, we undertook an analysis of sentencing decisions in all federal district courts between 1986
Crime and Justice, 1999
Until the 1970s, a sentence to imprisonment deprived one not only of liberty but also put one'... more Until the 1970s, a sentence to imprisonment deprived one not only of liberty but also put one's health at risk. Medical care was inadequately available and frequently primitive. This changed when federal courts intervened, forcing improvements in prisoners' care. Rights to adequate care were established, standards were promulgated, medical staffs were expanded, and providers in the surrounding community were called on to fill gaps. Spending for prisoners' health care consequently rose dramatically. Prison administrators began adopting various "managed care" procedures to allocate resources in less costly and more efficient ways. These include efforts to buy needed goods and services in the larger health care marketplace at more advantageous prices, establishing controls and incentives to reduce unnecessary care, and contracting with private firms to manage and deliver care. Imprisoned criminals are the only persons in the United States enjoying a constitutional right to adequate health care. Support for state-funded care of prisoners may become more precarious if free citizens continue to lack similar legal rights and access to universal health care.
Crime and Justice, 1992
Some argue that operation and ownership of correctional facilities is a core responsibility of go... more Some argue that operation and ownership of correctional facilities is a core responsibility of government. The historical record indicates otherwise. Private parties long played a central role in the administration of penal sanctions in Great Britain and the United States. By the twentieth century, government assumed operational responsibility for most adult correctional facilities. Privately owned or operated juvenile facilities in the United States have been more common and in 1989 held about 40 percent of all juveniles confined. Proliferation of private juvenile facilities did not reduce reliance on large public correctional institutions; confinement in public facilities rose over the past several decades. Privately operated correctional facilities for adults emerged with much fanfare in the mid-1980s, touching off a debate about the proper and constitutional roles of private and public agencies. Both research and experience are likely to show that private facilities can exploit specific conditions in specific jurisdictions and can deliver more cost-effective service in these places, but that claims of the private sector's inherent superiority over public correctional management will not be borne out.
The British Journal of Sociology, 1993
ABSTRACT Typescript (photocopy) Thesis (Ph. D.)--Columbia University, 1983. Bibliography: leaves ... more ABSTRACT Typescript (photocopy) Thesis (Ph. D.)--Columbia University, 1983. Bibliography: leaves 291-302.
ABSTRACT Incluye bibliografía
The Fortune Society, located in New York City, provides various services on a voluntary basis to ... more The Fortune Society, located in New York City, provides various services on a voluntary basis to offenders who have been incarcerated previously, at an average cost (in 2005) of about $3,265 per client. This study examines the extent to which receipt of these services reduces recidivism and homelessness following release. Recidivism is measured by an arrest leading to conviction; homelessness is indicated by a request to the NYC Department of Homeless Services for shelter. Fortune clients released to NYC from state prisons or from NYC jails during 2000-2005 are examined and their outcomes are compared to outcomes observed for state prisoners or local jail inmates released during same period but who did not go to Fortune. Multivariate survival analyses and propensity score analyses are used to estimate program effects on recidivism. No evidence of positive effects on recidivism is found. Indeed, Fortune clients were more likely to recidivate than non-clients, even after controlling f...
Military Medicine, 2020
IntroductionThe use and misuse of opioids by active service members has been examined in several ... more IntroductionThe use and misuse of opioids by active service members has been examined in several studies, but little is known about their spouses’ opioid use. This study estimates the number of military spouses who received high-risk or long-term opioid prescriptions between 2010 and 2014, and addresses how the Military Health System can help prevent risky prescribing in order to improve military force readiness.Materials and MethodsThis study used data from the Millennium Cohort Family Study, a nationwide survey of 9,872 spouses of service members with 2 to 5 years of military service, augmented with information from the military’s Pharmacy Data Transaction Service about prescriptions for controlled drugs dispensed to these service members’ spouses. Our objectives were to estimate the prevalence of opioid prescribing indicative of long-term use (≥60 day supply or at least one extended-release opioid prescription in any 3-month period) and, separately, high-risk use (daily dosage of...
Pain medicine (Malden, Mass.), Jan 30, 2018
This research looked at whether notifying prescribers and pharmacies about patients who use multi... more This research looked at whether notifying prescribers and pharmacies about patients who use multiple providers to obtain opioids reduces their prescribing activity (including use of multiple providers, numbers of opioid prescriptions, or amounts of opioids obtained). Nevada's prescription drug monitoring program (PDMP) identified patients using multiple providers to obtain opioids and assigned them alternately to an intervention or control group. Controlled substance prescription histories were sent only to intervention patients' providers. Subsequent opioid purchases by patients in both groups were compared. All pharmacies and dispensers in the state are required to report every prescription for Schedule II-IV opioids dispensed to the PDMP. All patients receiving opioids from more than four different Nevada prescribers and more than four pharmacies during the previous six months assigned to the intervention (N = 436) or control group (N = 441). We used ordinary least square...
Abstract : The report first maps out the different components which contribute to the organizatio... more Abstract : The report first maps out the different components which contribute to the organization of applied social research. Two chapters then compare various models by which research can be incorporated into an organization and review the factors which affect the various solutions. Finally, the work of policy science centers is singled out for special analysis. They are a recent and growing development; the implications of this trend are discussed. (Author)
Pharmacoepidemiology and drug safety, 2014
This study estimates the prevalence in US counties of opioid patients who use large numbers of pr... more This study estimates the prevalence in US counties of opioid patients who use large numbers of prescribers, the amounts of opioids they obtain, and the extent to which their prevalence is predicted by ecological attributes of counties, including general medical exposure to opioids. Finite mixture models were used to estimate the size of an outlier subpopulation of patients with suspiciously large numbers of prescribers (probable doctor shoppers), using a sample of 146 million opioid prescriptions dispensed during 2008. Ordinary least squares regression models of county-level shopper rates included independent variables measuring ecological attributes of counties, including rates of patients prescribed opioids, socioeconomic characteristics of the resident population, supply of physicians, and measures of healthcare service utilization. The prevalence of shoppers varied widely by county, with rates ranging between 0.6 and 2.5 per 1000 residents. Shopper prevalence was strongly correl...
Psychiatric Services, 2013
OBJECTIVE This study estimated the prevalence of stimulant treatment among both adults and childr... more OBJECTIVE This study estimated the prevalence of stimulant treatment among both adults and children at national, state, and county levels during 2008 and explored explanations for wide variations in treatment prevalence. METHODS Records of 24.1 million stimulant prescriptions dispensed to insured and uninsured patients were obtained from approximately 76% of U.S. retail pharmacies. Data were weighted to estimate treatment prevalence on March 15, 2008, for all U.S. states and counties. Regression models were used to estimate the associations among the counties' treatment rates and the characteristics of the counties and their resident populations. RESULTS An estimated 2.5% of children ≤ 17 years of age (3.5% of males and 1.5% of females) and .6% of persons >17 years of age were being treated with stimulants in March 2008. Treatment prevalence among states varied widely, and variation among counties was even wider. Two-thirds of the variation among counties in treatment prevalence was associated with supply of physicians, socioeconomic composition of the population, and, among children, funding for special education. Rates of children and adults in treatment were highly correlated. CONCLUSIONS Wide variations in treatment prevalence signal disparities between established clinical practice guidelines and actual practice, especially for primary care, where most patients prescribed stimulants are managed. Better education and training for physicians may improve identification and treatment, thereby reducing disparities in care for attention-deficit hyperactivity disorder and other disabling conditions.
The Journal of Pain, 2012
Estimates of geographic variation among states and counties in the prevalence of opioid prescribi... more Estimates of geographic variation among states and counties in the prevalence of opioid prescribing are developed using data from a large (135M) representative national sample of opioid prescriptions dispensed during 2008 by 37,000 retail pharmacies. Statistical analyses are used to estimate the extent to which county variation is explained by characteristics of resident populations, their healthcare utilization, proxy measures of morbidity, availability of healthcare resources, and prescription monitoring laws. Geographic variation in prevalence of prescribed opioids is large, greater than variation observed for other healthcare services. Counties having the highest prescribing rates for opioids were disproportionately located in Appalachia and in Southern and Western states. The number of available physicians was by far the strongest predictor of amounts prescribed, but only one-third of county variation is explained by the combination of all measured factors. Wide variation in prescribing opioids reflects weak consensus regarding the appropriate use of opioids for treating pain, especially chronic non-cancer pain. Patients' demands for treatment have increased, more potent opioids have become available, an epidemic of abuse has emerged, and calls for increased government regulation are growing. Greater guidance, education and training in opioid prescribing are needed for clinicians to support appropriate prescribing practices. Perspective-Wide geographic variation that does not reflect differences in the prevalence of injuries, surgeries, or conditions requiring analgesics raises questions about opioid prescribing practices. Low prescription rates may indicate under-treatment, while high rates may indicate overprescribing and insufficient attention to risks of misuse.
Federal Sentencing Reporter, 1994
Although the intent of the Sentencing Reform Act of 1984 ("SRA," hereafter) was to elim... more Although the intent of the Sentencing Reform Act of 1984 ("SRA," hereafter) was to eliminate disparities in sentences imposed by federal judges, differences in imprisonment sentences received by black, white, and Hispanic offenders grew more pronounced after full implementation of the guidelines. That is, imprison ment sentences meted out to blacks grew increasingly harsher, on average, relative to whites and Hispanics, during the first year and a half following full imple mentation of the guidelines (that is, after the U.S. Supreme Court's decision in Mistretta). At the request of the U.S. Department of Justice's Bureau of Justice Statistics, we undertook an analysis of sentencing decisions in all federal district courts between 1986
Crime and Justice, 1999
Until the 1970s, a sentence to imprisonment deprived one not only of liberty but also put one'... more Until the 1970s, a sentence to imprisonment deprived one not only of liberty but also put one's health at risk. Medical care was inadequately available and frequently primitive. This changed when federal courts intervened, forcing improvements in prisoners' care. Rights to adequate care were established, standards were promulgated, medical staffs were expanded, and providers in the surrounding community were called on to fill gaps. Spending for prisoners' health care consequently rose dramatically. Prison administrators began adopting various "managed care" procedures to allocate resources in less costly and more efficient ways. These include efforts to buy needed goods and services in the larger health care marketplace at more advantageous prices, establishing controls and incentives to reduce unnecessary care, and contracting with private firms to manage and deliver care. Imprisoned criminals are the only persons in the United States enjoying a constitutional right to adequate health care. Support for state-funded care of prisoners may become more precarious if free citizens continue to lack similar legal rights and access to universal health care.
Crime and Justice, 1992
Some argue that operation and ownership of correctional facilities is a core responsibility of go... more Some argue that operation and ownership of correctional facilities is a core responsibility of government. The historical record indicates otherwise. Private parties long played a central role in the administration of penal sanctions in Great Britain and the United States. By the twentieth century, government assumed operational responsibility for most adult correctional facilities. Privately owned or operated juvenile facilities in the United States have been more common and in 1989 held about 40 percent of all juveniles confined. Proliferation of private juvenile facilities did not reduce reliance on large public correctional institutions; confinement in public facilities rose over the past several decades. Privately operated correctional facilities for adults emerged with much fanfare in the mid-1980s, touching off a debate about the proper and constitutional roles of private and public agencies. Both research and experience are likely to show that private facilities can exploit specific conditions in specific jurisdictions and can deliver more cost-effective service in these places, but that claims of the private sector's inherent superiority over public correctional management will not be borne out.
The British Journal of Sociology, 1993
ABSTRACT Typescript (photocopy) Thesis (Ph. D.)--Columbia University, 1983. Bibliography: leaves ... more ABSTRACT Typescript (photocopy) Thesis (Ph. D.)--Columbia University, 1983. Bibliography: leaves 291-302.
ABSTRACT Incluye bibliografía