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DATA ON A POST-DOBBS WORLD
WPCNR YOUR LOCAL EPIDEMIOLOGIST By Dr. Katelyn Jetelina. November 7, 2022. Reprinted with permission.
Public health touches on all aspects of our lives, not just during a pandemic. Thanks to your feedback, this newsletter will continue with COVID updates but will start touching on other epidemiological topics, too.
Last week 5 new studies provided a first look into Dobbs v. Jackson’s impact on access to abortion care. This was largely thanks to JAMA Network that published a special issue on this topic. This is the story that data is telling.
Shift in location of abortions
Just like with COVID-19, data fragmentation touches nearly every other public health problem, including abortion. The Society of Family Planning anticipated this problem and started counting clinical abortions (i.e. at a physical location) beginning in 2022. They coin this effort #WeCount.
They just released their first report:
- Two months post-Dobbs, 10,600 fewer people had clinical abortions—a 6% decrease on a national level.
- Among states that banned or severely restricted abortion, there was a 95% decrease.
- States with the largest percent increases in abortions included North Carolina (37%), Kansas (36%), Colorado (33%), and Illinois (28%). California experienced virtually no change (1%), although still had the most abortions.
- This was an interesting pattern. Some states with restrictions in place (like North Carolina) experienced a surge because they were just closer in distance to states that banned abortion altogether, such as Indiana and Georgia. States on the East and West coasts, though, experienced little to no change.
A JAMA Network publication looked solely at Texas (remember Texas passed a highly restrictive before Dobbs in September 2021 called SB8). Specifically, scientists counted all abortions in the state of Texas from September 1, 2020 to February 28, 2022 and evaluated whether abortions increased, decreased, or stayed the same after SB8:
- Over the entire time period, there were 68,820 Texas facility–based abortions and 11,287 out-of-state abortions among Texas residents.
- After SB8, documented abortions among Texas residents decreased 33%.
- After SB8, out-of-state abortions among Texas residents increased from 17% to 31%. In other words, out-of-state abortions did not fully offset the overall decrease in facility abortions post-SB8.
Requests for medication abortion increase
Clinical abortion is not the only option for women. There is a very safe and effective alternative that people can access online and take at home—medication abortion. Another JAMA Network study looked at requests for medication before Dobbs, after Dobbs leaked, and after the Dobbs formal announcement. They found:
- More than 42,000 requests for abortion medications across 30 states.
- Requests in every state, regardless of policy, increased after the leak and the formal announcement.
- States with total bans had the highest increase in requests. Louisiana had the most medication requests followed by Mississippi, Arkansas, Alabama, and Oklahoma.
Travel time increases
Clinics closed, which increased travel times for people seeking in-person abortion care. A study in JAMA Network assessed exactly how much:
- Travel times to abortion facilities, on average, increased by three times.
- The largest increases were across the South (see figure below). In Texas, for example, the new travel time to the nearest abortion facility increased by almost a full workday.
- American Indian or Alaska Native, Black, and Hispanic populations experienced large absolute increases in travel time to abortion facilities.
Travel Time to Nearest US Abortion Facility Before and After Dobbs v Jackson Women’s Health US Supreme Court Decision. FromRader et al., JAMA Network. Source here.
Pregnancies among young girls are risky
A news story post-Dobbs went viral after an Indiana doctor provided abortion services to a 10-year-old Ohio rape victim. A recent study published the risks of pregnancy to the youngest of girls. The scientists looked at the negative impact (morbidity, mortality, and delivery outcomes) of over 90,000 pregnancy hospitalizations among the youngest of girls (under age 13 years) compared to older females. They found that compared to other pregnancies, pregnancies among 10-13 year olds led to:
- More preterm births
- More C-sections
- More preeclampsia cases
- More ICU admissions
- No difference in stillbirths
It’s clear the youngest girls who give birth face significant medical risks.
Bottom line
Early data shows Dobbs significantly changed the way in which people access abortion care in the U.S.: where to go, how to get it, what barriers they’ll face, and who can get it (health inequities). In just four short months post-Dobbs, thousands of women’s lives were impacted. This is just the beginning of the story, but we have the power to decide how medical care for women, and this map, look going forward. Go vote.
Abortion Laws by State (Source: Center for Reproductive Rights)
MANHATTAN DOCTOR CONVICTED AT TRIAL OF ILLEGALLY DISTRIBUTING OXYCODONE. 1.3 million prescriptions distributed from November 2017 to Sept. 2022
WPCNR FBI WIRE. From the Federal Bureau of Investigation. Tuesday, November 8, 2022:
Damian Williams, the United States Attorney for the Southern District of New York, announced Friday that a federal jury found HOWARD ADELGLASS guilty for his participation in a conspiracy to illegally prescribe oxycodone.
The defendant was found guilty following a two-week trial before U.S. District Judge Jed S. Rakoff. Sentencing is scheduled for March 8, 2023, before Judge Rakoff.
U.S. Attorney Damian Williams said:
“Doctor Howard Adelglass was a drug dealer, but instead of peddling drugs on the street corner, he distributed drugs with a prescription pad from his Central Park South ‘pain-management clinic.’
For years, the defendant prescribed enormous quantities of highly addictive and deadly opioids to people he knew were suffering from substance abuse disorders or were dealers.
By distributing mammoth quantities of oxycodone pills to people without a legitimate medical purpose, the defendant destroyed lives and families. Along with our law enforcement partners, we will continue to hold accountable those responsible for fueling the opioid crisis that is ravaging our community and nation.”
According to the allegations contained in the Indictment, the evidence offered at trial, and matters included in public filings:
HOWARD ADELGLASS was a licensed physician. Together with Marcello Sansone, the defendant operated a pain-management clinic located in Midtown Manhattan (the “Clinic”). The Clinic serviced purported patients seeking oxycodone and other pain-relief medications commonly diverted for illicit purposes.
In exchange for cash payments, and in some instances for cocaine, ADELGLASS wrote thousands of prescriptions for large quantities of oxycodone, and many he wrote to individuals whom ADELGLASS knew did not need the pills for a legitimate medical purpose.
When they occurred, ADELGLASS’s examinations were perfunctory.
The defendant’s purported patients included individuals addicted to opioids and, in some cases, who sold oxycodone on the street. Even when faced with clear evidence of his purported patients’ drug abuse and diversion, ADELGLASS continued to prescribe large quantities of oxycodone to them.
Initially, ADELGLASS staffed the Clinic with inexperienced young women, some of whom he addicted to oxycodone.
In approximately October 2018, after serving as a primary source of patient referrals, Sansone took over as the Clinic’s office manager. In that role, Sansone helped to control access to ADELGLASS and the lucrative prescriptions he wrote for medically unnecessary oxycodone.
With particularly vulnerable patients, the defendants solicited and, in some instances, received sex acts in exchange for oxycodone prescriptions.
Between in or about November 2017 and in or about September 2020, ADELGLASS prescribed more than 1.3 million oxycodone pills.
On October 13, 2022, Sansone pled guilty to conspiracy to illegally distribute oxycodone. Sansone is scheduled to be sentenced on February 13, 2023, before Judge Rakoff.
* * *
ADELGLASS, 67, of New York, New York, was convicted of conspiracy to illegally distribute oxycodone, which carries a maximum sentence of 20 years in prison.
The maximum potential sentence in this case is prescribed by Congress and is provided here for informational purposes only, as any sentencing of the defendants will be determined by the judge.
Mr. Williams praised the outstanding investigative work of the Federal Bureau of Investigation, the New York City Police Department, and the Department of Health and Human Services, Office of the Inspector General.
This case is being handled by the Office’s Narcotics Unit. Assistant U.S. Attorneys Nicholas W. Chiuchiolo, Marguerite B. Colson, and Daniel G. Nessim are in charge of the prosecution.
GENEROUS DONOR INTENDS TO DISTRIBUTE 1,000 THANKSGIVING MEALS TO GREENBURGH’S POOREST
Elmsford Irrigation Entrepreneur Bernardo Luciano Wants to Feed People in Need
If you want to volunteer and help distribute meals or if you know of residents, local non profits that would benefit from the meals please contact Greenburgh Supervisors office 914-989-1540
GREENBURGH, NY_ Central Turf & Irrigation Supply, headquartered in Elmsford, is a family business owned and operated by Bernardo Luciano. His daughter Camilla Sorvillo approached the Town Supervisor’s office recently about a vision her father has of serving up to 1,000 meals this Thanksgiving day to Greenburgh residents most in need. He and his company do various large-scale philanthropic acts several times a year, but distributing warm Thanksgiving meals is something he would now like to make an ongoing tradition. The Greenburgh Neighborhood Health Center will generously open their space on Knollwood Road to this large event on Thanksgiving day.
The Greenburgh Health Center, a site of the Mount Vernon Neighborhood Health Center, Inc., is a 501 (c)(3) non-profit organization that offers high quality primary, preventive, and affordable health care and support services in an atmosphere of humane care, dignity and respect to improve the health and lives of adults, teens, and children in Westchester County and the Bronx.
Bernardo Luciano emigrated by himself to the US from Italy in 1970 at the age of 15. Once here, Bernardo began working in restaurants, supermarkets, and drove a taxi at night before landing a job as a landscape contractor. That started his lifelong career in the Green Industry. During his first few years on the job, he became intrigued by irrigation and its ability to create beautiful landscapes. Embracing his inner entrepreneur, Bernardo was determined to get into the irrigation business. And, he did just that. Bernardo left his job with the landscaping company and went to work for an irrigation contractor. After a few years as an employee, he became a partner in the business. Five years after that, he was ready to go out on his own, starting his own successful irrigation contracting business in Elmsford.
After selling his business in 1995, Bernardo purchased Central Irrigation Supply. With the help of his devoted wife Filomena, daughter Camilla, and son Anthony, Bernardo grew Central from one location in Connecticut to the largest family-owned and operated landscape supply company in North America—with more than 58 locations throughout the US and Canada and with 300 employees. The headquarters has been in Elmsford since around 2002.
The Luciano family has lived here in Elmsford since 1985. Though Bernardo and his wife recently moved to Connecticut, he still considers this home-base and wants to give back to the community and greater Greenburgh in general for the opportunities given to him here.
One-thousand warm Thanksgiving dinners – ordered from local fine grocer and another family business DeCicco & Sons – will be served by volunteers including members of Central Turf & Irrigation along with John DeCicco Sr. at the Greenburgh Health Center on 295 Knollwood Road Thursday November 24 from 11:30-1:30 pm.
We are attempting to track how many meals are needed as closely ahead of time as possible by handing out red ticket stubs to those attending. We ask for the assistance of local groups who serve the needy, like churches and shelters, to let us know how many meals you might need for your community. With advance notice, the meals can be packaged for take-out to distribute at your own location, or you can help hand out a batch of tickets to your community to come eat at the GHC in person at staggered time slots of 11:30 am, 12 noon, 12:30 pm and 1:00 pm.
Please contact Krista Madsen in Supervisor Paul Feiner’s Office for more information and to reserve tickets for your group at [email protected] or 914.989.1540. We also invite local youth groups to create Thanksgiving decorations to make the dining space welcoming and festive. We want to make sure that we are giving the meals to only those who are most deserving.
We are grateful for your assistance in helping us get these meals to the right people who need them most, and especially to the Lucianos, DeCiccos and everyone at the Greenburgh Health Center for making this event possible.
Paul Feiner
Greenburgh Town Supervisor