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Andres Roman-Urrestarazu

2021–22 U.K. Harkness Fellow in Health Care Policy and Practice; Senior Research Associate, Department of Psychiatry, University of Cambridge; Assistant Professor, Maastricht University; Consultant Clinical Academic Staff, Public Health England

Andres Roman

Placement: Stanford University

Mentor: Keith Humphreys, Ph.D., Esther Ting Memorial Professor, Stanford Health Policy Associate, Stanford School of Medicine

Co-mentor: Richard Frank, Ph.D., Margaret T. Morris Professor of Health Economics, Department of Health Care Policy, Harvard Medical School

Project: Health System Responses to the Opioid Epidemic in the United States

Andres Roman-Urrestarazu, M.D., Ph.D., M.Sc., is a 2021–22 U.K. Harkness Fellow in Health Care Policy and Practice. He is a psychiatrist, public health clinician, and Senior Research Associate at the University of Cambridge. He is also an Assistant Professor at Maastricht University and an Honorary Consultant Clinical Academic Staff at Public Health England. Roman-Urrestarazu was previously a Gillings Fellow in Global Public Health (2016–2020). He is a Member of the Faculty of Public Health and a Board Member of the International Society for the Study of Emerging Drugs (ISSED), and worked as Civil Servant in the Centre for Health Technology Evaluation (CHTE) at the National Institute for Health and Care Excellence (NICE). His research lies at the intersection of health policy and public mental health, with a focus on the intersection of health inequalities and the economic determinants of adverse mental health outcomes in the field of substance use and addiction. Roman-Urrestarazu’s work has been published in leading health policy and medical journals, including JAMA Pediatrics, BMJ, and Health Policy, and has directly informed policy. In 2016, he submitted evidence to the House of Commons for the UK Psychoactive Substances Act. He has a Ph.D. in Psychiatry from the University of Cambridge, M.D. from the University of Santiago in Chile, and M.Sc. in International Health Policy from the London School of Economics and Political Science.

Project Overview: The opioid epidemic is among the most pressing public health problems in the United States. According to the Centers for Disease Control and Prevention, between 1999 and 2019 nearly 500,000 people died of opioid overdose, with deaths increasing 28.8 percent in 2020. Despite the urgent need for improving the accessibility and uptake of opioid misuse treatment, systemic barriers persist, particularly with respect to the type and mode of treatment available. Opioid agonist treatments (OATs), such as methadone or buprenorphine, are cost-effective and evidence-based, especially when compared to abstinence-based treatments. Nevertheless, OATs have historically been subject to heightened scrutiny in the U.S. and are strictly regulated by the Drug Addiction Treatment Act (DATA).

The primary aim of this project is to investigate how Opioid Treatment Programs (OTPs) have been implemented at the federal and state levels, and how recent policy reform has dealt with this public health challenge. We will analyze how health providers across different states and subregions of the U.S. have responded to the Affordable Care Act (ACA) OTPs policy framework and the types of treatments offered, using a mix of data on claims, treatment episodes, provision of substance use disorder services, and treatment facilities. We will further investigate how the ACA has affected the uptake of evidence-based interventions and assess the impact on opioid epidemic outcomes (admission, mortality). We aim to describe trends in addiction treatment facility operations and whether disparities emerge based on socioeconomic and demographic characteristics of vulnerable subgroups.