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Background Relapse is common in major depressive disorder (MDD). In this study, we evaluated the incremental health care burden of relapse in patients with MDD. Methods This real-world retrospective cohort study used administrative medical and pharmacy claims data to identify commercially insured adult patients in the United States diagnosed with MDD who initiated a new antidepressant between January 1, 2012, and September 30, 2017. All-cause health care resource utilization, total costs, and medication adherence were evaluated in two cohorts: patients with and patients without relapse. Relapse was defined as suicide attempts, psychiatric hospitalization, mental health–related emergency department (ED) visit, use of electroconvulsive therapy, or reinitiation of treatment after a gap ≥6 months. Results The study population included 14,186 patients (7093 baseline-matched patients per cohort). The mean follow-up period was 27.5 and 26.0 months for patients with and patients without relapse, respectively. Patients with relapse had significantly higher rates of hospitalization (16.6% vs 8.5%; p <  .0001) and ED visits (54.8% vs 34.7%; p <  .0001) than patients without relapse. The total costs for patients with relapse were significantly higher ($12,594 vs $10,445;  p <  .0001). Patients with relapse were also less adherent to antidepressants (mean proportion of days covered, 0.43 vs 0.49; p <  .0001). Conclusions Relapse of MDD was associated with increased total costs and health care utilization and lower adherence to antidepressants. Reducing the risk of relapse may result in a reduction of the associated health care burden; however, findings may only be generalizable to patients with commercial insurance.

Background The estimated prevalence of comorbid major depressive disorder (. MDD) is 11% in patients with type 2 diabetes (T2D) and 15–20% in those with cardiovascular disease (CVD). Comorbid MDD continues to be a significant source of economic burden to the healthcare system. Methods We assessed the incremental healthcare burden of comorbid MDD in patients with T2D or CVD. This real-world, retrospective, administrative claims study analyzed commercially insured adults with T2D or CVD diagnosed on at least 2 separate claims within 12 months of each other (between January 1, 2011, and September 30, 2018). CVD included congestive heart failure, peripheral vascular disease, coronary heart disease, and cerebrovascular disease. The study compared patients with and without MDD with either T2D or CVD. Study assessments included all-cause healthcare resource utilization (proportion of patients with hospitalization, emergency department [ED] visits, and outpatient visits) and cost. Results Patients were matched by propensity score for demographics and baseline characteristics, resulting in similar baseline characteristics for the respective subcohorts. After matching, 22,892 patients with T2D (11,446 each with and without MDD) and 28,298 patients with CVD (14,149 each with and without MDD) were included. At follow-up, patients with T2D and MDD had significantly higher rates of hospitalization (26.1% vs 17.4%, P  < 0.0001) and ED visits (55.3% vs 43.0%, P  < 0.0001) than those observed in patients without MDD. The total cost for patients with T2D and MDD at follow-up was significantly higher than for those without MDD ($16,511 vs $11,550, P  < 0.0001). Similarly, at follow-up, patients with CVD and MDD had significantly higher rates of hospitalization (45.4% vs 34.1%, P  < 0.0001) and ED visits (66.5% vs 55.4%, P  < 0.0001) than those observed in patients without MDD. Total cost at follow-up for patients with CVD and MDD was significantly higher than for those without MDD ($25,546 vs $18,041, P  < 0.0001). Conclusions Patients with either T2D or CVD and comorbid MDD have higher total all-cause healthcare utilization and cost than similar patients without MDD. Study findings reinforce the need for appropriate management of MDD in patients with these comorbid diseases, which in turn may result in cost reductions for payers. Trial registration Not applicable.

Oddly, criminal prohibition can lead to “commoning,” when individuals, left unprotected by state and formal property rights, innovate collective systems to access, use, and benefit from illegalized resources. “Legalization” entails the conversion of these prohibited commons to legal property systems, bringing new freedoms and liberties as well as the dispossession of collectively generated assets (material, relational, and otherwise). This paradox of legalization is currently playing out among U.S. states moving to legalize cannabis. Motivated by the failures of cannabis prohibition and its grievous harms, the question looms: How will states and markets grapple with the collectively generated assets and relational systems generated under prohibition? Building from ethnographic research and survey data, this article argues for recognition of the commoning practices that produced the resources upon which the legal market is based. These practices illuminate ways that legalization may deliver not only markets and regulation but also emancipatory justice in the wake of the War on Drugs. First, we document the commoning practices of cannabis cultivators, the collective benefits they generated under prohibition, and how legalization is affecting these practices and dynamics. Second, we explore strategies, like allotment and pricing systems, that build from prohibited commoning practices to achieve greater collective benefits and the emancipatory potential of legalization.

Despite its ongoing federal illegality, marijuana production has become a licit, or socially accepted, feature of northern California's real estate market. As such, marijuana is a key component of land values and the laundering of \"illegal\" wealth into legitimate circulation. By following land transaction practices, relations, and instruments, this article shows how formally equal property transactions become substantively unequal in light of the \"il/legal\" dynamics of marijuana land use. As marijuana becomes licit, prohibitionist policies have enabled the capture of ground rent by landed interests from the marijuana industry at a time when the price of marijuana is declining (in part due to its increasing licitness). The resulting \"drug war rentier nexus,\" a state–land–finance complex, is becoming a key, if obscured, component within marijuana's contemporary political economy.

Oddly, criminal prohibition can lead to “commoning,” when individuals, left unprotected by state and formal property rights, innovate collective systems to access, use, and benefit from illegalized resources. “Legalization” entails the conversion of these prohibited commons to legal property systems, bringing new freedoms and liberties as well as the dispossession of collectively generated assets (material, relational, and otherwise). This paradox of legalization is currently playing out among U.S. states moving to legalize cannabis. Motivated by the failures of cannabis prohibition and its grievous harms, the question looms: How will states and markets grapple with the collectively generated assets and relational systems generated under prohibition? Building from ethnographic research and survey data, this article argues for recognition of the commoning practices that produced the resources upon which the legal market is based. These practices illuminate ways that legalization may deliver not only markets and regulation but also emancipatory justice in the wake of the War on Drugs. First, we document the commoning practices of cannabis cultivators, the collective benefits they generated under prohibition, and how legalization is affecting these practices and dynamics. Second, we explore strategies, like allotment and pricing systems, that build from prohibited commoning practices to achieve greater collective benefits and the emancipatory potential of legalization.

Prohibitions, according to many , are moments in which social strictures override individual behavior, forming a foundation for social interaction. Cannabis prohibition does not simply proscribe behavior, it generates administrative apparatuses, innovates conceptual vocabularies, shapes social relations, and much more. In liberal capitalist societies, ideologically premised as they are on the free barter, truck, and trade of goods, prohibition is a unique mode of governance. The placement of prohibited realms beyond regulatory reach enables them to develop their own social systems, with their own symbolic codes, languages, ethics, circuits of knowledge, and such. Prohibition also requires a governance apparatus for its material-discursive administration. Legalization may be defined as a moment of policy regime shift, coming in several forms. In Amador County in the Sierra Foothills, cannabis was translated to legal forums through the register of \"land use\". Legalization generates unique social forms.

BackgroundTardive dyskinesia (TD) is a movement disorder associated with prolonged exposure to antipsychotics. The current study was designed to describe demographics and comorbidities for patients with a dyskinesia diagnosis as probable TD (cohort 1), patients likely to have undiagnosed/uncoded TD (cohort 2), and a control population.MethodsThis retrospective study analyzed Medicaid claims data from July 2013-March 2017. For a pool of patients with a history of 3 months or more of taking an antipsychotic, three cohorts were evaluated: cohort 1 (ICD-9/10 codes for dyskinesia); cohort 2 (propensity score matching to cohort 1); and cohort 3 (patients withschizophrenia, major depressive disorder [MDD], and/or bipolar disorder [BD] and history of ≤2 antipsychotic medications). Outcomes included patient characteristics, Charlson Comorbity Index (CCI) and healthcare utilization (pre-and post [12-month] period).ResultsCohort sizes and characteristics were: cohort 1 (n=1,887; female, 68%; mean age, 42 years; MDD, 17%; BD, 48%); cohort 2 (n=1,572; female, 58%; mean age, 39 years; MDD, 22%; BD, 48%); cohort 3 (n=25,949; female, 67%; mean age, 40 years; MDD, 11%; BD, 49%). Cohorts 1 and 2 had higher comorbidity burden than cohort 3 (mean pre-index CCIs: 0.68, 0.79, and 0.47, respectively; p<0.001 for each cohort). After 12 months, mean per member per year healthcare costs were higher in cohort 1 and2 compared to cohort 3 ( $21,293, $ 18,988, and $11,522, respectively), as were mean claims per member per year (185, 138, and 109, respectively).ConclusionIn the study population, patients likely suffering from TD, ICD-9/10 code-confirmed or unconfirmed, have a higher overall comorbidity burden and healthcareutilization than those who probably do not have TD.Funding AcknowledgementsThis study was funded by Neurocrine Biosciences, Inc.

Since the 1996 voter approval of medical marijuana laws in California, marijuana policy has become increasingly liberalized. Producers, however, have remained in the greyest of grey market zones. Federal anti-drug laws and supply-side tactics have intensively targeted them even as marijuana has become more licit. In this legally unstable environment, marijuana patient-cultivators and underground producers have begun to articulate and assert themselves politically and economically, particularly as the likelihood of full legalization increased. This dissertation explores how producers navigated the nebulous zone between underground and medical markets. I argue that even as producers supplied marijuana to a formalizing, regulated medical industry they proved trenchantly resistant to government regulation. In the process they carved out new claims on citizenship, well being, property rights, community, and relations to nature. This politics provides an insight into how the emergence of marijuana production into civic life is transforming the political economy of rural and exurban Northern California, a region that has been a historical locus of marijuana production in the United States. More broadly, this politics from the informal-illegal margins offers a unique insight into the role of domestic marijuana producers in challenging the global War on Drugs. As a gateway moment for “the gateway drug,” this dissertation points to the new drug war détente. The dissertation is based on 19 months of participant-observation fieldwork in Northern California, spanning from 2010 to 2014. It is focused on two subregions: the North Coast and the Sierra Foothills. Both case studies are explored in three chapters focused on: the historical entrenchment of marijuana prohibition and production; the destabilization of these systems as producers vied for political voice; and the governmental retrenchment of the War on Drugs. Prior to these explorations, I narrate a legal, medical, and economic history of marijuana and, in conclusion, I explore some of the implications of this study for our understanding of Northern California’s political economy, domestic marijuana politics, politics of the new peasantry and the informal market, systems of criminalization and social control and recent efforts to reform them, and the relation of the War on Drugs to the arc of US global empire.